Transcript for:
2024 ICD-10-CM General Coding Guidelines

hi guys welcome back to codemaster coach your medical coding tutor okay guys let's continue our review of the 2024 icd-10-cm official coding guidelines if you have not yet had a chance to go in and review these guidelines go back to last Thursday's video I uploaded a video on the part one a of the official coding guidelines all right let me minimize my box and let's get started again we are at B we've already done a and now we're officially at B okay let me first show you the official coding guidelines B is General coding guidelines number one locating a code in the icd-10-cm says to select a code in the classification that corresponds to a diagnosis or reason for visit documented in a medical record first locate the term in the alphabetic index and then verify the code in the tabular list read and be guided by instructional notations that appear in both the alphabetic index and the table list it is essential to use both the alphabetic index and tabular list when locating and assigning a code the alphabetic index does not always provide the full code let me say that again the alphabetic index does not always provide the full code selection of a full code including laterality and any applicable seventh character can only be done in the tabular list a dash at the end of an alphabetic index entry indicates that additional characters are required even a dash is not included in the alphabetic index entry it is necessary to refer to the tabular list to verify that no seventh character is required so let me show you my notes there are three steps to coding one locate the main term in the alphabetic index two verify the code in the tabular list and three assign the verified code assign the code that you confirmed in the tabular list before assigning so how do you locate a main term in the alphabetic index the main term describes the condition of the patient not the body part so for example breast Mass the main term in breast mass is what the main term is in bold print starts with a capital letter and is farthest to the left So based on the condition breast Mass I would look up Mass so here it should say Mass okay sub terms are indented to the right under the main term they're in regular type with the lowercase letter So based on the condition breast Mass I would look for breast under the main term Mass so let me show that to you here's a replica of the alphabetic index we're under the main term Mass and we're going to go down to breast and there's your code okay all right referring back to those official coding guidelines what's the level of detail in coding diagnose these codes are used and reported at their highest number of characters available and to the highest level of specificity documented in the medical record icd-10-cm diagnosis codes are composed of codes with three four five six or seven characters remember I9 we went as far as five but with I-10 we've got seven characters codes with three characters are included in the icd-10-cm as the heading of a category or codes that maybe further subdivided by the use of fourth fifth sixth each which provides greater detail or specificity a three character code is to be used only if it is not further subdivided a code is invalid if it has not been coded to the full number of characters required for that code including the seventh character if applicable and I tried to make this a little clearer here where I said if I needed even more specificity some subterms have additional sub terms indented further to the right under the previous subterm I call these Sub sub terms for example with the main term Mass underneath there's a sub term abdominal and then there's a Sub sub term epigastric it's describing greater specificity of the mass that is in the abdominal area but for specificity it's telling you it's in the epigastric region and we know that the epigastric area is right above your umbilical your navel so when I go to the previous here where it had Mass and then subterm abdominal notice its mass is bull print flush left starts with a capital letter main term Mass sub term indented starts with the lowercase regular print abdominal sub term but identifying it as epigastric where I'm giving a Sub sub term it's further indented underneath the first subterm there's the epigastric or 19.06 all right the alphabetic index does not always provide the full code so selection of the full code including laterality and any applicable seventh character can only be done in the tabular list and there's usually a dash at the end of an alphabetic index entry that indicates that additional characters are required but even if a dash is not included in your alphabetic entry your alphabetic index entry it's necessary to refer to the tabulous to verify that no seventh character is required so let's refer to main term Mass and sub term here so let me go to Mass sub term ear see how that h93.8 has this box with the check in it for this aapc icd-10-cm book the H9 3.8 it's a box with the check in it that lets me know additional characters are required so when I looked that code up h93.8 it's right here H9 3.8 notice it's saying check the fifth well h938 is four so I need that fifth character but when I get to that fifth character h938x it's saying I need six characters so it's going to be h938x1 or two it's going to be all the way up to six characters no matter what it's either 8 1 8x2 8x3 or 8x9 so h938 can expand all the way up to six codes six digits therefore this code must be a six digit code I can't stop at five and I can't stop at four it's not a legitimate code unless I carry it out all the way to the number of characters for that particular category and in this case subcategory okay let's keep going all right number two let's refer back to the guidelines level of detail and coding diagnose these codes are to be used and Report okay we just did this part here we did two let me make sure my notes cover that as well too level yeah refer to the guideline H9 3.8 above we did that all right let's go back to the guidelines we're at three I want you to see it in the guidelines and then I add my little touches code or codes from a 0 0.0 through t88.9 and z00 through z99.8 and our new code is u00 through u85 says the appropriate code of codes from this category these categories must be used to identify diagnoses symptoms conditions problems complaints or other reasons for the encounter or visit so my codes just say straight from the guidelines I agree with exactly what it's saying here at 3. forces signs and symptoms codes that describe symptoms and signs as opposed to diagnoses are acceptable for reporting purposes when a related definitive diagnosis has not been established or confirmed by the provider and chapter 18 of icd-10-cm symptom signs and abnormal clinical and laboratory findings not elsewhere classified contain many but not all codes for symptoms main thing I I wanted to stress here with number four was do you know the difference between a symptom and a sign I always say symptoms are observed from the patient doc I'm having these headaches dark I'm light-headed I'm dizzy these are my symptoms as the patient so the as I'm telling my doctor my symptoms ding ding ding these are signs to the doctor or the physician of a disease process so again symptom patient sign physician okay all right five let's look at number five conditions that are an integral part of a disease process signs and symptoms that are associated routinely with the disease process should not be assigned as additional codes unless otherwise instructed by the classification so it's exactly what it's saying here if these symptoms add up to this diagnosis then don't call the symptom codes just code the diagnosis code because that's what these symptoms are up lightheaded a little dizzy not feeling well head is hurting oh you got hypertension oh so I just if the doctor says these are symptoms of hypertension patient does have hypertension I just called hypertension I don't code the signs and symptoms I just called the definitive diagnoses so again conditions that are integral part of the disease process are captured under that disease process six I think we covered six as well conditions that are not an integral part of the disease process additional signs and symptoms that may not be Associated routinely with the disease process should be coded when present if it doesn't lead to a definitive diagnoses then code the sign or symptom seven multiple coding for a single condition in addition to the etiology which means cause or manifestation which is a result of either it's the cause of the disease or scarring that's the result of a burn conventions that require two codes to fully describe a single condition that affects multiple body systems there are other single conditions that also require more than one code use additional code notes are usually found in your tabular list at codes that are not a part of an etiology or manifestation pair where a secondary code is useful to fully describe a condition the sequencing rule is the same as the etiology manifestation pair use additional code indicates that a secondary code should be added if known and they gave you an example here bacterial infections that are not included in chapter one it says a secondary code from category b95 which identifies streptococcus staphylococcus and enterococcus as the cause of diseases classified elsewhere or b-96 other bacterial agents as the cause of diseases classified elsewhere may be required to identify the bacterial organism causing the infection so a use additional code note will normally be found at the Infectious Disease code indicating a need for the organism code to be added as a secondary code so let me show you that and then also code first let me show you multiple coding for a single condition all right we refer to the guidelines paragraphs one and two did we cover two as well with the code first okay but let me show you this at n39.0 you'll want to learn that in 39.0 is urinary tract infection so n39 .0 right there urinary tract infection site not specified but if you have a urinary tract infection you know it's an infection it's telling you here use an additional code from b95 through b97 to identify the Infectious agent so if it's a u a urinary tract infection due to E coli then I would go under main term infection find E coli and use that as an additional code because it's telling me here in my tabular list that I need an additional code to identify the infectious disease just like my coding guidelines told me here that I might need an additional code if the code at the tablet doesn't include the Infectious organism use an additional code to identify the Infectious agent and then you also you'll see code first they're also under certain codes that are not specifically manifestation codes but may be due to an underlying cause so when there's a Code first note and an underlying condition is present then the underlying condition should be sequenced first if known in other words if they didn't have this other underlying condition then more than likely they didn't wouldn't have whatever condition they have today and then you have a code if applicable any causal condition first there's a note that indicates that this code may be assigned as a principal diagnosis when the causal condition is not unknown or not applicable so if a causal condition is known then code that condition and sequence it as your principal first listed diagnoses and multiple codes may be needed for sequela which is a result of or a complication code and obstetric codes to more fully describe a condition so let's look back at what makes your covering everything I have on my guidelines for this only thing I have here is like code first diabetic retinopathy you know that retinopathy is a disease of the retina in the eye but if it's a diabetic retinopathy then it's saying that because of this patient's diabetes today they have retinopathy Now understand you can have retinopathy without diabetes but in the case of a diabetic retinopathy then is letting me know that due to the patient's diabetes now they have retinopathy so when I go to coded retinopathy diabetic it's going to tell me see diabetes first code first diabetes and encode if applicable any causal condition first I use the example of insomnia due to a medical condition if you're unable to sleep at night due to another condition then that other condition should be identified first because that's the reason that today you have insomnia okay hopefully this makes sense and when I look up insomnia I didn't identify the code here here it is insomnia g47.0 is telling me I need a fifth digit to to code it but notice at insomnia due to a medical condition it's telling me here code also any Associated medical conditions so if they're coming in today for the insomnia then that would be coded first but if there's an underlying condition follow the guidelines of your classification icd-10-cm will show you will tell you how to appropriately code that here it says code also any Associated medical condition okay eight acute and chronic conditions so let's go to the guidelines on number eight if the same condition is described as both Subacute acute or sub-acute and chronic and separate sub-entries exist in your alphabetic index at the same indention level code both and sequence the acute or sub-acute code first so first thing I ask you here is what is the difference between acute and chronic we know that acute is immediate it's happening now it's urgent we're chronic is ongoing it's not immediate it's usually long term so if you know the difference between the specificities with the two acute and chronic then you can understand putting acute conditions first and in combination codes let me go to combination for nine a combination code is a single code used to classify two diagnoses or a diagnosis with Associated secondary process or manifestation which we just identified or a diagnosis with an Associated complication combination codes are identified by referring to subterm entries in the alphabetic index and by reading the inclusion and exclusion notes in the tabular list remember we talked about inclusion and exclusion in last week's video assign only the combination code when that code fully identifies the diagnostic conditions involved or when the alphabetic index so directs multiple coding should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnoses and when the combination code lacks necessary specificity in describing the manifestations or complications an additional code should be used as a secondary code and so I identified in nine an example was Canal liculitis acute and chronic this condition can be both acute and chronic in the same patient so if we looked up canaliculitis in your alphabetic index right there canaliculitis remember we talked about non-essential modifiers beside the main term so right here just at the main term it identifies acute and because chronic is indented underneath if I code chronic this stands for chronic but it will also include acute at this one code because this one code will include chronic by itself or because acute is a non-essential modifier which means it's still here this isn't chronic is indented underneath canaliculitis then this one code identifies both acute and chronic and be careful because notice at The Chronic there's some more digits needed to appropriately code this condition all right so watch your indention levels but it identifies both acute here if I was just coding acute I'd use this code with the additional characters but because I'm identifying chronic and acute because chronic is indented this one code and the additional digits would include acute and chronic here all right let's keep going sequela sequela is under 10. a sequela is usually it says it is the residual effect it's a condition produced after the acute phase of an illness or injury has terminated there is no time and it's one thing I didn't it didn't stay with me there is no time then I can't say after six months no it could happen immediately it could be years later but there is no time limit on when a sequela code can be used says here the residual may be apparent early such as in a cerebral infarction or it may occur months or years later such as that due to a previous injury examples of a sequela include scar formation resulting from a burn a deviated septum due to a nasal fracture infertility due to tubal occlusion from old tuberculosis so coating of sequelae generally requires two codes sequence in the following order the condition or nature of the sequelae is sequenced first and then the sequela code is sequenced second an exception to the above guidelines are those instances where the code for the sequela is followed by a manifestation code identified in your tabular list and title or the sequela code has been expanded at the fourth fifth or sixth character level to include the manifestation and the code for the acute phase of an illness or injury that led to the sequela is never used with the code for the late effect and the only category that I know here it says here is it's been done in comp um complications of pregnancy childbirth in the paperum I've seen it in cerebral vascular disease most patients with the stroke the late effects of the Hemi uh paresis when they're paralyzed on one side Etc that category has been expanded to include the late effect with the current addition condition of patients experiencing make sure I covered everything sequela is the result of something for example a scar is a result of a burn so when I go on and the way you look them up is you go to main term sequella okay let's see how um cerebral vascular disease under sequela's right there and notice of the infarction is over here and those are categories that I know have been expanded to include the condition today as a result of a previous stroke all right impending or threatened conditions number 11. code any condition described at the time of discharge as impending or threatened when the doctor says you didn't quite miscarry yet but you're threatening a miscarriage or you're impending a myocardial infarction you're threatening to have a heart attack if it did occur then code as a confirmed diagnosis miscarriage heart attack coded as if it's confirmed but if it did not occur then reference the alphabetic index to determine if the condition has a sub entry for impending or threatened and also reference main term entries impending or threatened if the sub terms are listed then assign the given code if the sub terms are not listed code the existing underlying condition and not the condition described as impending or threatened and that's pretty much what I'm saying here is if the condition says impending or threatened go to main term impending or threatened did I make a copy of those yeah see here here's impending coronary syndrome delirium tremens myocardial infarction so if you're threatening a myocardial infarction there's a code here's threatened let me find it on here and threatened here it is threatened abortion abuse job loss anxiety concern labor Etc all of these loss of job miscarriage unemployment so go to those main terms but if the condition was not listed here then it's telling me go to that condition encoded as confirmed if I can't find it under impending or threatened all right we're at number 12 reporting the same diagnosis code more than once each unique they said unique for a reason icd-10-cm diagnosis code may be reported only once for an encounter I can remember in ICD-9 if it was bilateral we assigned the code two times we don't need that anymore with ICD-10 because now ICD-10 has been expanded to identify right left bilateral unspecified Etc so this applies to bilateral conditions when there are no distinct code identifying laterality or two different conditions classified to the same icd-10-cm diagnoses code it's there are coding now identifies the same diagnoses more than once okay I think those those guidelines are really clear if there's any questions let me know and then even with laterality let's look at 13 it says refer to the guidelines it's self-explanatory some icd-10-cm codes indicate laterality which means right or left specifying whether the condition occurs on the left the right or bilateral if no bilateral code is provided and the condition is bilateral then assign separate codes for both the left and right and if the side is not identified in the medical record then assign the code for the unspecified side when a patient has a bilateral condition and each side is treated during separate encounters then assign the bilateral code as the condition still exists on both sides including for the encounter for treat to treat the first side so even if they're only treating one side because the patient has that condition bilaterally then you're it's appropriate to code it bilaterally and then for the second encounter for the treatment after one side had previously been treated and the condition no longer exists on that side then assign the appropriate unilateral because remember they already corrected the other side by the time you're coming in for the second treatment for the side where the condition still exists and you see that quite a bit with cataract surgery that's performed on each eye they tend to do one eye at a time says the bilateral code would not be assigned for the subsequent the second encounter as the patient no longer has the condition in the previously treated site and if the treatment on the first side did not completely resolve the condition then the bilateral code would still be appropriate when laterality is not documented by the patient's provider code assignment for the affected side may be based on the medical record documentation from other clinicians if you find it document in the chart that it was on the right The Physician didn't tell you then long as the documentation identifies which side then you're okay to code it and if there is conflicting medical record documentation regarding the affected side then the provider patients provider should be queried for clarification and encodes for unspecified side should rarely be used when the documentation and record is sufficient to determine the effects affected side and it is not possible to obtain clarification so again as always tell my coders review the entire record anyway when coding just for that clarity 14 documentation by clinicians other than the patient's provider did I have anything more at 13 nope in 14 I just said refer to the guidelines so let's read those guidelines at 14. code assignment is based on the documentation by the patient's provider this provider could be a physician or other qualified health care practitioner legally accountable for establishing the patient's diagnoses there are a few exceptions when code assignment may be based on medical record documentation from clinicians who are not the patient's provider in this context clinicians other than the patient's provider refers to Health Care Professionals permitted based on regulatory accreditation requirements or internal Hospital policies to document in a patient's official medical record and some of these exceptions include if the physician says the patient is has obesity morbid obesity Etc we tend to look for body mass index BMI even the depth of non-pressure chronic ulcers if the physician just says patient has ulcers chronic ulcers nurses tend to document the level or the depth of the ulcer so we can do that same here with pressure ulcer staging nurses tend to grab that more document that more than Physicians and you're okay to grab it there Coma Scale NIH Stroke Scale social determinants of Health laterality blood alcohol levels we always check the lab on those so we can identify what it is and under immunization status with blood alcohol levels and body mass index I always say when I'm teaching it that a lot of times patients don't think they're obese when it comes to obesity but that BMI helps you determine that same thing with your alcohol level patients will say oh I'm not intoxicated but their blood alcohol level states that they're over a certain limit therefore they are intoxicated these are additional um codes that we can add for the specificity that we need to justify the provider's documentation and so it just says here the information is typically or maybe documented by other clinicians involved in the care of the patient notice it's a dietitian however the associated diagnoses must be documented by the patient's provider and if there's conflicting medical record documentation either from the same clinician or different clinicians then the patient's provider should be queried for clarification because I always tell my coders we code physician documentation physician said it we can code it however that nursing the labs the x-rays the other ancillary Services can give us greater specificity in our coding to more accurately code so long as it corresponds with what the physician says patient is obese then we can go to that BMI to prove that obesity is there all right so that's 13 and 14 yep refer to the guidelines all right now 15 talks about syndromes let's look at syndromes it says follow the alphabetic index guidelines when coding syndromes in the absence of the alphabetic index guidance assign codes for the documented manifestations of syndromes additional codes for manifestations that are not an integral part of the disease process may also be assigned when the condition does not have a unique code so only thing I did here was copy the page in my alphabetic index for syndromes and guys look this is Pages all three of these lines on that one page and this is just one page from the 2024 icd-10-cm alphabetic index to disease and injuries and syndrome it took up I think about three of these full Pages for just syndromes so there are quite a few all right we're at 16 documentation of complications of care now code assignment is based on the provider's documentation of the relationship between the condition and the care or procedure unless otherwise instructed by the classification the guideline extends to any complications of care regardless of the chapter the code is located in so realize it is important to note that not all conditions that occur during or following medical care or surgery are classified as complications there must be a cause and effect relationship between the care provided and the condition and the documentation must support that the condition is clinically significant it is not necessary for the provider to explicitly document the term complication for example if the condition Alters the course of the surgery as documented in the op report then it would be appropriate to report a complication code query the provider for clarification if the documentation is not clear as to the relationship between the condition and the care or procedure biggest thing I want to say here is remember a complication is usually something that went wrong as a result of there needs to be as they State here a cause and effect relationship because of this occurring this happened that's where complication comes in because this was treated this happened that's a complication it Alters the care make sure I have nothing else at 16. all right now we're getting ready to go into 17. borderline diagnoses if the provider documents a borderline diagnoses at the time of discharge then the diagnosis is coded as confirmed unless the classification provides a specific entry for example borderline diabetes I think we hear that quite a bit if a borderline condition has a specific index entry in icd-10-cm it should be coded as such borderline diabetes since borderline conditions are not uncertain diagnoses no distinct measure since borderline conditions are not uncertain diagnoses no distinction is made between the care setting inpatient versus outpatient whenever the documentation is unclear regarding a borderline condition coders are encouraged to query for clarification make sure I don't have anything else put in here yep and I showed you what it looks like under borderline so if I go to the main term borderline right there you have borderline diabetes mellitus borderline hypertension borderline osteopenia borderline pelvis with obstruction during labor or borderline personality all of these are borderline conditions but again remember what your guideline says if a borderline condition has a specific index entry then it should be coded but if it's not then you code it as if confirmed all right use of signing symptoms use of sign symptoms and unspecified codes sign symptom and unspecified codes have acceptable even necessary uses since while specific diagnosis code should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient's health condition there are instances when signs symptoms or unspecified codes are the best choice for accurately reflecting the health care encounter each Health Care encounter should be coded to the level of certainty known for that encounter says you're as stated in the introductory section of these official coding guidelines a joint effort between the health care provider and the coder is essential to achieve complete and accurate documentation code assignment and reporting of diagnoses and procedures the importance of consistent complete documentation in the medical record cannot be overemphasized without such documentation accurate coding cannot be achieved the entire record should be reviewed to determine the specific reason for the encounter and the conditions treated and I always tell my coders this we code physician documentation yes but read the entire record know what's going on with your patients so that you can more accurately code it and if a definitive diagnosis has not been established by the end of the encounter it's appropriate to report codes for signs and or symptoms in Louie of a definitive diagnosis when sufficient clinical information isn't known or available about a particular health condition to assign a more specific code it is acceptable to report the appropriate unspecified code and they gave you an example of pneumonia didn't tell you what type just said patient has pneumonia the unspecified code should be reported when they are they are the codes that most accurately reflect what is known about the patient's condition at the time of that particular encounter it would be inappropriate to select a specific code that is not supported by the medical record documentation or conduct medically unnecessary diagnostic testing in order to determine a more specific code so again we said earlier that symptoms are from the patient and as the patient tells the physician their symptoms there's signs to the position of a disease process but sometimes your symptoms don't lead to a definitive diagnosis and if a definitive diagnoses cannot be determined then all you can code are these signs or symptoms and I see that quite a bit on an outpatient basis with going to your Physician's office with a headache a lot of times they will treat headache but you'll learn that a headache is an indication of something else going on in the body it could just be stress sleep you need a lack of sleep anxiety Etc but because when you went to the physician's office and you're lucky to spend 10 to 15 minutes in the office with the physician all they hear is headache then they're just going to treat headache if it's anything more you'll come that headache will eventually lead to the definitive diagnoses but if all your physician treats in that little 10 or 15 minutes in their office is the headache then all we can code is headache okay let's keep going with our guidelines we are down to 18 yes we did 18. so let's see what else I have just refer to the guidelines there straight to the point I agree all right 19 code for Health Care Encounters in Hurricane aftermath we're almost finished guys all right and these come straight from the guidelines I agree with this use of external cause of morbidity codes and I'm being told that external cost coding is State dependent it depends on which state you're in whether or not you capture these codes but just know that an external cause of morbidity code should be assigned to identify the cause of injuries incurred as a result of the hurricane the use of external cause of morbidity codes is supplemental to the application of icd-10-cm codes external cause of morbidity codes are never to be recorded as a principal diagnosis or first listed put all your diagnoses codes first and then your last code should be identifying the external cause and remember there's a separate index for these the appropriate injury code should be sequenced before any external cause codes the external cause of morbidity codes capture how the injury or health condition happened which is the cause the intent was an unintentional or accidental or was it intentional such as a suicide or an assault the place where the event occurred the activity of the patient at the time of the event and the person's status were they civilian were they military they should not be assigned for encounters to treat hurricane victims medical conditions with no injury or adverse effect or poisoning is involved external cause of morbidity codes should be assigned for each encounter for care and treatment of the injury external costs and morbidity codes may be assigned in all Health Care settings for the purpose of capturing complete and accurate icd-10-cm data in the aftermath of the hurricane a health care setting should be considered as any location where Medical Care is provided by licensed Health Care Professionals and how do we sequence these codes for catalystic events such as hurricane take priority over all other external cause codes except child and adult abuse and terrorism and should be sequenced before other external cause of injury codes so again we'll do these external cause codes especially the hurricane first unless this child abuse or adult abuse or terrorism says assign as many external cause of morbidity codes as necessary to fully explain each cause for example if an injury occurs as a result of a building collapse during the hurricane external cost codes for both the hurricane and the building collapse should be assigned with the external causes code for the hurricane be seek being sequenced as the first external cause code and for injuries occurred as a direct result of the hurricane assign the appropriate codes for the injuries Then followed by the x-37.0 hurricane and in any other applicable external cause of injury codes now that code X 37.0 also should be assigned when an injury is incurred as a result of flooding caused by a levy breaking related to a hurricane and x38 flood should be assigned when an injury is from flooding resulting directly from the storm x-36.0 and notice those additional digits collapse of a dam or man-made structure should not be assigned when the cause of the collapse is due to the hurricane the use of x36.0 is limited to collapses of man-made structures due to Earth's surface movements not due to storm surges directly from a hurricane and then others include injuries that are not a direct result of the hurricane such as an evacuee that has occurred incurred in injury as a result of a motor vehicle accident then assigned the appropriate external cause of morbidity code to describe the cause of the injury but do not assign the x-37.0 hurricane if it is not clear whether the injury was a direct result of the hurricane then assumed the injury is due to the hurricane and a sign X 37.0 hurricane as well as any other applicable external cause of morbidity codes in addition to codex 37.0 for Hurricane other possible applicable external costs and morbidity codes include x30 exposure to excessive natural heat X31 exposure to excessive natural cold and x-38 flood make sure I don't have anything else like that on here so I just have one here um for a the use of external cost of morbidity codes you want to code how activity place and Status those are the four external cause codes and the straightforward as far as the sequencing and other external cause of morbidity codes and then the last part of this B says use of Z codes um Z codes which other reasons for healthcare encounters may be assigned as appropriate to further explain the reason for presenting for health care services include transfers between Health Care Facilities or provide additional information relevant to a patient's encounter icd-10-cm Official Guidelines for coding and Reporting identify which codes may be assigned as principal or first list to diagnoses only secondary diagnoses only or principal first listed or secondary depending on the circumstances so make sure with this you check to make sure is the Z code a z code that can only be a first listed or is this a z code that cannot be a first listed and it will tell you in your classification in icd-10-cm particularly in the tabular list it will say this code can only be a primary or principal diagnosis code so pay attention to those possible applicable Z codes include homelessness inadequate housing extreme poverty persons awaiting admission to an adequate facility elsewhere unavailability and inaccessibility of Health Care Facilities unavailability and inaccessibility of other helping agencies encounter for health supervision and care of other healthy infants and child encounter for Respiratory or ventilator dependence during power failure so can you see how these Z codes tend to be a little different there are other reasons for Health Care encounters other they're not actual diagnoses but their other but it it justifies Health Care Services so we need to code them all right let's see external costs and morbidity codes and the Z code listed above are not an all-inclusive list other codes may be applicable to the encounter based upon the documentation assign as many codes as necessary to fully explain each Healthcare encounter and since patient history information may be very limited use any available documentation to assign the appropriate external cause of morbidity and Z codes other Z codes that I'm shocked that aren't listed on here are um allergies to penicillin sulfa different things that Physicians need to be aware of all right let me double check my guidelines when I pulled them over use of Z codes that's it guys we have finished b one b of the 2024 icd-10-cm official coding guidelines my next video will be on chapter on C we're getting into chapter specific coding guidelines all right guys thanks for taking this journey with me hopefully I'm bringing better understanding of these official coding guidelines to you any questions feel free to email me at codemastercoach Gmail and next Thursday I will be back and we'll pick up C thanks guys I'll see you in the next one