Coding Counts

HCC 79 – Seizures

April 20, 2018

This month we are focusing on ICD-10 Category G40 – Seizures.

The codes in this category are:

ICD-10 Description
G40.0 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset
G40.1 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures
G40.2 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures
G40.3 Generalized idiopathic epilepsy and epileptic syndromes
G40.4 Other generalized epilepsy and epileptic syndromes
G40.5 Epileptic seizures related to external causes
G40.8 Other epilepsy and recurrent seizures
G40.9 Epilepsy, unspecified

When selecting a code from Category G40, it’s important to assign the appropriate 5th and 6th characters to identify if the seizure is intractable versus not intractable and with or without status epilepticus.

In order to select the code with the highest level of specificity, the documentation must indicate if the seizure is:

  • Focal or generalized
  • Idiopathic or symptomatic
  • With or without status epilepticus
  • Intractable or not intractable

According to the instructional notes, these terms are to be considered equivalent to intractable:

  • Pharmacoresistant (pharmacologically-resistant)
  • Treatment-resistant
  • Refractory (medically)
  • Poorly controlled

If you have any questions or would like to talk more about coding for this or any other chronic conditions, contact us at


AAPC ICD-10 CM Expert for Physicians and Hospitals
Mayo Clinic

Autoimmune Diseases and ICD-10

March 16, 2018

Autoimmune diseases cause the body to produce antibodies that attack its own tissues, leading to deterioration, and in some cases destruction, of tissue.

Many autoimmune diseases that carry a higher risk to the patient’s health are defined in ICD-10 nomenclature, but codes are not narrowed down to one particular section.


Type 1 Diabetes

Age can be misleading with Type 1 diabetes. Don’t let a patient’s age determine your code selection since either type of diabetes can occur at almost any age. You should also remember that diabetes can come with multiple complications, and ICD-10 guidelines let you use as many codes within a particular category as you need to accurately indicate an individual’s health status.

When coding diabetes with manifestations, make sure you assign the appropriate additional digits needed to identify the type of complication.

ICD-10 Code Description
E10.1 – E10.11 Type 1 diabetes mellitus with ketoacidosis with or without coma
E10.2 – E10.29 Type 1 diabetes mellitus with kidney complications
E10.3 – E10.37 Type 1 diabetes mellitus with ophthalmic complications
E10.39 Type 1 diabetes mellitus with other diabetic ophthalmic complication
E10.5 – E10.59 Type 1 diabetes mellitus with circulatory complications
E10.6 – E10.69 Type 1 diabetes mellitus with other specified complication
E85.0 – E85.9 Amyloidosis


Heart Conditions

If there is a causal relationship between hypertension and a heart condition, a code from I50.- or I51.4-I51.9 must be assigned to a code from category I11 (Hypertensive heart disease). If there is no causal relationship between hypertension and the heart condition, they must be coded separately. Sequence the codes according to the circumstances of the encounter.

ICD-10 Code Description
I24.1 Dressler’s syndrome
I51.4 Autoimmune myocarditis


Other Risk-Adjusted Autoimmune Conditions

ICD-10 Code Description Coding Guidelines
D59.0*, D59.1, D68.61 Severe Hematological Disorders *Use additional code for adverse effect, if applicable identify drug (T36-T50 with fifth or sixth character 5)
D89.82, D89.89* Disorders of Immunity *Excludes human immunodeficiency virus disease (B20)
G35, G36.0 Multiple Sclerosis
G37.3, G90.1 Spinal Cord Disorders & Injuries
G61.0, G61.81, G70.00, G70.01, G70.80, G70.81, G73.1*, G72.41 Myasthenia Gravis, Myoneural Disorders, and Guillain-Barre Syndrome, Inflammatory and Toxic Neuropathy *Code first underlying neoplasm (C00-D49)
K50.00 – K50.919, K51.80 – K51.919 Inflammatory Bowel Disease Use additional code to identify manifestations, such as pyoderma gangrenosum (L88)
K74.3 Cirrhosis of Liver Code also, if applicable, viral hepatitis (acute)(chronic)(B15-B19)
K75.4 Chronic Hepatitis
K86.1 Chronic Pancreatitis


ICD-10-CM Official Guidelines for Coding and Reporting
MedlinePlus Autoimmune Diseases

HCC 40 – Rheumatoid Arthritis

February 21, 2018

This month, we’re focusing on Rheumatoid Arthritis.

Rheumatoid Arthritis (RA) is a chronic autoimmune disease that progresses over time. It’s characterized by pain, swelling, and inflammation in the joints and surrounding tissues. It can also affect other organs in the body.

Things to remember when documenting and coding RA:

  • Laterality
  • Site
  • Joint vs. organ
  • With Rheumatoid factor (Seropositive) vs. without Rheumatoid factor (Seronegative)

ICD 10 Categories for RA

Rheumatoid Arthritis with Rheumatoid Factor

ICD 10 Category Category Description
M05.0** Felty’s Syndrome
M05.1** Rheumatoid lung disease with rheumatoid arthritis
M05.2** Rheumatoid vasculitis with rheumatoid arthritis
M05.3** Rheumatoid heart disease with rheumatoid arthritis
M05.4** Rheumatoid myopathy with rheumatoid arthritis
M05.5** Rheumatoid polyneuropathy with rheumatoid arthritis
M05.6** Rheumatoid arthritis with involvement of other organs and systems
M05.7** Rheumatoid arthritis with rheumatoid factor without organ or systems involvement
M05.8** Other rheumatoid arthritis with rheumatoid factor
M05.9** Rheumatoid arthritis with rheumatoid factor, unspecified

Rheumatoid Arthritis without Rheumatoid Factor

ICD 10 Category Category Description
M06.0** Rheumatoid arthritis without rheumatoid factor

Other Rheumatoid Arthritis

ICD 10 Category Category Description
M06.1 Adult-onset Still’s disease
M06.2** Rheumatoid bursitis
M06.3** Rheumatoid nodule
M06.4 Inflammatory polyarthropathy
M06.8** Other specified rheumatoid arthritis
M06.9 Rheumatoid arthritis, unspecified

**Add fifth character to designate site:

  • 0 – unspecified site
  • 1 – shoulder
  • 2 – elbow
  • 3 – wrist
  • 4 – hand
  • 5 – hip
  • 6 – knee
  • 7 – ankle and foot
  • 9 – multiple sites

Add sixth character to designate laterality:

  • 1 – right
  • 2 – left
  • 9 – unspecified side


Patient 1: 89-year-old female referred to Rheumatology for shoulder pain and stiffness. Patient has pain and stiffness in multiple joints and complains of swelling in both wrists and hand. This has been going on for many months.

Patient is diagnosed with seronegative rheumatoid arthritis affecting multiple joints.

The correct code for this scenario is:
M06.09 – Rheumatoid arthritis without rheumatoid factor, multiple sites

Patient 2: 51-year-old female returns to rheumatology clinic for follow up on seropositive RA of right wrist.

The correct code for this scenario is:
M05.731 – Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement

Notice that in both examples the laterality and site were documented with ease.

For more coding tips, check out the rest of Coding Counts, or if you have any questions, email us directly at


AAPC ICD-10 CM Expert for Physicians and Hospitals

HCC 54 and HCC 55 – Substance Abuse

January 9, 2018

This month we’re taking a look at substance abuse, its definition, criteria, and the differences between use and dependence.

This is the code range for the conditions related to substance abuse:

ICD-10 Code Description
F10.1-F10.19 Alcohol abuse
F11.1-F11.19 Opioid abuse
F12.1-F12.19 Cannabis abuse
F13.1-F13.19 Sedative, hypnotic or anxiolytic abuse
F14.1-F14.19 Cocaine abuse
F15.1-F15.19 Other stimulant abuse
F16.1-F16.19 Hallucinogen abuse
F18.1-F18.19 Inhalant abuse
F19.1-F19.19 Other psychoactive substance abuse

Psychoactive substance abuse is the use of any substance for nontherapeutic purposes or the use of medication for purposes other than what it’s prescribed for, such as:

  • Use of illicit drugs, like cocaine
  • Misuse of prescribed drugs that stimulate or depress the central nervous system, like amphetamines or barbiturates
  • Habitual use of substances that are commercially available with desired effects, like alcohol

The Differences Between Use and Dependence

Substance Use Dependence

When a psychoactive substance is used to treat a behavioral or mental health disorder.

For documentation purposes, psychoactive substance use must be linked to a mental health or behavioral disorder by a provider.

ICD-10 coding guidelines identify 3 criteria for a definite diagnosis of dependence:

  1. A strong desire or sense of compulsion to take the substance
  2. Difficulties in controlling substance taking behavior
  3. Physical withdrawal symptoms when substance has ceased or has been reduced

ICD-10 coding guidelines also define a hierarchy of reportable psychoactive substance use, abuse, and dependence code designations. When multiple terms (use, abuse, and dependence) are found in provider documentation, only one ICD-10 code should be reported:

  • If use and abuse are documented, report only the code for abuse.
  • If use and dependence are documented, report only the code for dependence.
  • If abuse and dependence are documented, report only the code for dependence.
  • If use, abuse, and dependence are all documented, report only the code for dependence.


ICD-10-CM Expert for Physicians
McGraw-Hill concise dictionary of modern medicine ©2002

RxHCC Model

December 21, 2017

The second major HCC based risk adjustment model is the RxHCC model. The RxHCC model was created for Medicare Part D and Medicare Advantage plans. This model, like the CMS HCC model, can predict benefit costs that the plan will be responsible for covering and adjust standardized payments based on the underlying health status of the plan’s members.

Rx condition categories describe major diseases and are broadly organized into body systems. Like the HCC model, they’re also categorized into hierarchies. This prevents multiple diagnoses in the same disease group from increasing the risk score when they shouldn’t.

An RxHCC risk score of 1.0 means a member covered by standard Part D Medicare benefits is expected to incur the average liability amount for prescription drugs.

These are some examples of RxHCC diagnoses that are commonly overlooked in yearly reports:

RxHCC Diagnoses ICD-10 Code
134 Major depressive disorder, single episode, unspecified F32.9
188 Old myocardial infarction I25.2
187 Essential (primary) hypertension I10
166 Most Migraine diagnoses G43.001-G43.919
87 Age related osteoporosis without current pathological fracture M81.0
68 Gastroesophageal reflux disease without esophagitis K21.9
45 Pure hypercholesterolemia E78.00
42 Hypothyroidism, unspecified E03.9
226 Mild persistent asthma, uncomplicated J45.30
226 Mild intermittent asthma, uncomplicated J45.20
315 Psoriasis vulgaris L40.0


CMS website Medicare Managed Care Manual Chapter 7 Risk Adjustment