MRC135 - ICD10: Diagnostic Coding

Week 2: ICD-10-CM Guidelines

You may only code confirmed cases of HIV infection.

Read more about how to code HIV infections in the guidelines (Section I.C) related to Chapter 1 in your ICD-10-CM book.

Readings

The following readings will help you learn about the concepts covered this week.

Required Reading
  • Understanding Health Insurance, Chapter 6, “ICD-10-CM Coding,” pp. 198-206
  • ICD-10-CM Official Guidelines for Coding and Reporting 2016:
  • -Section I.B-I.C
    -Sections II-IV

Chapter 6

ICD-10-CM Guidelines

The ICD-10-CM coding guidelines are a set of coding and sequencing-related rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. The guidelines help you choose the right codes and correctly report them.


You must assign codes in accordance with the General Coding Guidelines. To do otherwise would be incorrect and possibly fraudulent. Therefore it is extremely important for you to be comfortable with the guidelines and see how they apply to each coding situation.


There are two sets of guidelines in the ICD-10-CM: General guidelines and chapter-specific guidelines. The general guidelines apply to all coding you will do with ICD-10-CM. They specifically explain how to use ICD-10-CM to locate a code; how to report the correct level of detail; when to report signs and symptoms as opposed to specific diagnoses; and how to select diagnoses in special circumstances (such as when you might select multiple codes for a single condition). The chapter-specific guidelines apply only to specific chapters within ICD-10-CM.

For example, one of the general guidelines directs you to report diagnosis codes to the highest level of characters available for the code. If a code can have six characters, it is incorrect to report only five characters for that code. This rule applies whether you are coding a neoplasm, anemia, thyrotoxicosis, megalencephaly, or any other diagnosis in the ICD-10-CM book.


Chapter-specific guidelines are in Section C and they are organized by chapter. Before coding a case that involves a specific chapter, go to the chapter and read the guidelines to ensure that you are applying the code correctly. For example, if you are about to code diabetes, be sure to review the coding guidelines for Chapter 4—there are many requirements to consider when coding this condition, and your final selection depends on the type and detail of documentation you have available in the case file.


After reviewing the coding guidelines in your ICD-10-CM book, click the link to play a matching game to connect guidelines to their definition and use.


Drag-and-Drop Matching

ICD-10-CM Exercises

As you complete your required readings, you will see exercises throughout your textbook. These exercises will help you identify important information about the guidelines in ICD-10-CM. They will also help you prepare for the graded quiz.

Complete the following practice exercise found in Chapter 6 in your text:

  • Exercise 6-8 (nos. 1-10 only)

Then click the link to compare the answers to your own work.

Exercise Answers

Coding Practice

To summarize what you have learned, and to prepare for the graded coding assignment, complete the following coding practice activity. Click the link to download a document and practice assigning ICD-10-CM codes according to the guidelines.

Coding Practice


When you’re ready, click the link to check your answers.

Coding Practice Answers