ICD-10 Specific Complaint FAQS

Specific Complaint FAQs

Q: Is the ICD-10 code for sciatica different that low back pain?
Yes. The low back pain codes to M54.5, while sciatica codes to M54.3 with further specificity as to laterality (M54.31 right side and M54.32 left side). Additionally, there are separate codes for lumbago with sciatica which includes M541.41 for right side lumbago with sciatica and M54.42 for left side lumbago with sciatica.

Q: What about obstetric (OB) cases?
Documentation of trimester is required. To determine trimester, calculate from the first day of last menstrual period and is documented in weeks as follows:

First trimester: Less than 14 weeks, 0 days
Second trimester: 14 weeks, 0 days – 27 weeks, 6 days
Third trimester: 28 weeks – delivery

Other OB concepts in ICD-10:

  • The time frame for differentiating between early and late vomiting in pregnancy has been changed 22 to 20 weeks
  • The time frame for a missed abortion (vs fetal death) has changed from 22 to 20 weeks
  • In ICD-10-CM, an elective abortion is now described as an elective termination of pregnant
  • There are four spontaneous abortion definitions in ICD-10; use the appropriate definition in your documentation
    • Missed abortion no Bleeding, os closed
    • Threatened abortion Bleeding, os closed
    • Incomplete abortion Bleeding, os open, products of conception (POC) are extruding
    • Complete abortion Possible bleeding or spotting, os closed, all POC expelled
  • Documentation of conditions/complications of pregnancy need to distinguish between preexisting conditions or pregnancy related conditions
  • Include the following when documenting complications of pregnancy
    • Condition detail – was the condition preexisting, or present before pregnancy
    • Trimester – when did the pregnancy related condition develop?
    • Causal relationship – establish the relationship between pregnancy and the complication (e.g. preeclampsia)

Q: What are the changes in ICD-10 for Acute Myocardial Infarction (AMI)?
In ICD-10, AMI is considered acute for four weeks from the time of incident which is a change from ICD-9. Continue to report codes from category I21 for encounters while the MI is equal to or less than four weeks, including transfers to another acute setting or post acute care setting, and while the patient requires continued care for MI. For encounters after four weeks and while the patient is still receiving care related to the MI, the appropriate aftercare codes should be assigned. For an old or healed MI that does not require further care, code I25.2-ol MI may be assigned. Continue Reading http://practicemax.com/maxintel-demo/