ICD-9-CM Chapter 5

1. ICD-9-CM Chapter 5 Infectious Diseases Part 1

2. ICD-9-CM, Chapter 1 • Infectious and Parasitic Diseases • Divided based on etiology(cause of disease) • Many combination codes • Example: 112.0 candidiasis infection of mouth, which reports both organism and condition with one code

3. Multiple Codes • Sequencing must be considered • UTI due to Escherichia coli • 599.0 (UTI) etiology • 041.4 (E. coli) organism • 041 category is a secondary-code only

4. Section I.C.1.a,d,e Human Immunodeficiency Virus • Code HIV or HIV-related illness ONLY if stated asconfirmed in diagnostic statement • 042 HIV or HIV-related illness • V08 Asymptomatic HIV status • 795.71 Nonspecific HIV serology • Once an HIV diagnosis cannot code V08

5. Section I.C.1.a.2.f. Previously diagnosed HIV-related illness • Code prior diagnosis HIV-related disease 042 (HIV) • NEVER assign these patients to: • V08 (asymptomatic) or • 795.71 (Nonspecificserologic evidence of HIV)

6. Section I.C.1.a.2. Selection and sequencing of HIV codes • If admitted for HIV-related illness (e.g., pneumonia) • Code 042 (HIV) • Followed by current illness (Pneumocystiscarinii, 136.3) • If admitted for other than HIV-related illness • Codefirst-listed diagnosis • Then 042 (HIV) (Cont’d…)

7. Section I.C.1.a.2. Selection and sequencing of HIV codes (…Cont’d) • Sequence • Reason most responsible for encounter, if HIV (042) • Any additional diagnosis that impacts treatment

8. Section I.C.1.a.2.g. HIV infection in Pregnancy, Childbirth and the Puerperium • Exception to HIV sequencing • During pregnancy, childbirth, or puerperium, code: • 647.6X (Other specified infections and parasitic diseases) • Followed by 042 (HIV) (stated diagnosis) • Then any HIV-related illness (Cont’d…)

9. Section I.C.1.a.2.g. HIV and Pregnancy (…Cont’d) • Asymptomatic HIV during pregnancy, childbirth, or puerperium • 647.6X (Other specified infections and parasitic diseases) and • V08 (Asymptomatic HIV infection status)

10. Section I.C.1.a.2.e. Patients with inconclusive HIV serology • 795.71 (Inconclusive serologic test for HIV)

11. Section I.C.1.a.2.h. Encounters for testing for HIV • Code V73.89 (Screening for other specified viral disease) • Patient in high-risk group for HIV • V69.5 (Other problems related to lifestyle) • Patients returning for HIV screening results = V65.44 (HIV counseling)

12. Caution • Incorrectly applying these HIV coding rules can cause patient hardship • Insurance claims for patients with HIV usually need patient’s written agreement to disclose

13. Signs of Infection • Fever • Change in heart rate • Increased white blood cell count

14. Section I.C.1.b. Septicemia, Septic Shock and SIRS • Septicemia: systemic disease of microorganisms or their toxins in the blood (blood poisoning) • Septic shock: overwhelming infection due to severe sepsis • SIRS: Systemic Inflammatory Response Syndrome is a systemic response to infection/trauma • Sepsis refers to SIRS due to infection • Severe sepsis is sepsis with acute organ dysfunction

15. Section I.C.1.b. Septicemia, Septic Shock and SIRS (…Cont’d) • Code septicemia (038.XX) • Code SIRS with two codes: • First underlying systemic infection • Second (995.9X) Code Severe sepsis with three codes: First underlying systemic infection condition Second 995.92 Third, use additional code to identify organ failure

16. Coding Septic Shock • If documented, septic shock (785.52) should be reported • Septic Shock ( code four codes) • First code systemic infection • Second, 995.92 (or 995.94 if injury) • Third, code to identify organ failure • Fourth, 785.52 • Sepsis and septic shock associated with OB codes, also use code 630-633, Ectopic and Molar Pregnancy • Septic shock is never primary or first-listed diagnosis

17. Sepsis and Severe Sepsis not associated with noninfectious process • Infection resulting from Trauma, Other Serious Injury, Pancreatitis • Code Trauma/Injury • SIRS second (995.9X) • Any acute organ dysfunctions

18. Chapter 5 Conclusion - Infectious Diseases