Knowledge Base Article

The Signs and Symptoms category in I-9 has received a major overhaul in I-10. Not only have there been organizational changes; several new conditions have also been included in the chapter.  Let’s take a closer look at the differences...

• (Chapter 16) is now (Chapter 18)
• In addition to symptom guidelines, guidelines for several other conditions are listed in Chapter 18, i.e., Repeated falls, coma scale, functional quadriplegia, SIRS due to non-infectious process, and death nos
• Some of the symptoms previously found in a specific chapter, have been moved into the symptom chapter.
• Example 1: Hematuria, previously listed in the (Genitourinary System) is now listed in the (Symptoms) chapter
• Example 2: Sinus Bradycardia, previously listed in the (Diseases of the Circulatory System) is now listed in the (Symptoms) chapter
• Symptoms are sequenced by body system within the chapter (called blocks)

Chapter 18 is organized in the following blocks:

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The following is the beginning of the Symptom Chapter (block) for circulatory and respiratory systems in the tabular section:

R00 | Abnormalities of heart beat

R00.0 | Tachycardia, unspecified

NOTE

Reviewer’s Note: Sinus Bradycardia is now listed in the symptom chapter instead of in (Diseases of the Circulatory System) chapter as it was in I-9.

Rapid heart beat

Sinoauricular tachycardia NOS

Sinus (sinusal) tachycardia NOS

R00.1 | Bradycardia, unspecified

Sinoatrial bradycardia

Sinus bradycardia

Slow heart beat

Vagal bradycardia

R00.2 | Palpitations

Awareness of heart beat

R00.8 | Other abnormalities of heart beat

R00.9 | Unspecified abnormalities of heart beat

Official ICD-9-CM Guidelines for Coding and Reporting

Reviewer’s observation: I-9 previously provided only general guidelines for coding signs and symptoms under Section II. Selection of Principal Diagnosis. We now have chapter-specific guidelines for coding signs and symptoms in I-10.

I-9

Chapter 16: Signs, Symptoms and Ill-Defined Conditions (780-799)

Reserved for future guideline expansion

I-10

Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)

Chapter 18 includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded. Signs and symptoms that point to a specific diagnosis have been assigned to a category in other chapters of the classification.

1. Use of symptom codes
2. Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.
   
   
3. Use of a symptom code with a definitive diagnosis code
4. EXAMPLE
5. Respiratory arrest (R09.2) should not be coded in addition to Respiratory Failure (J96-).
6. Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code. Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.
   
   
7. Combination codes that include symptoms
8. ICD-10-CM contains a number of combination codes that identify both the definitive diagnosis and common symptoms of that diagnosis. When using one of these combination codes, an additional code should not be assigned for the symptom.
   
   
9. Repeated falls
10. Code R29.6, Repeated falls, is for use for encounters when a patient has recently fallen and the reason for the fall is being investigated.
11. Code Z91.81, History of falling, is for use when a patient has fallen in the past and is at risk for future falls. When appropriate, both codes R29.6 and Z91.81 may be assigned together.
    
    
12. Coma scale
13. The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale codes should be sequenced after the diagnosis code(s).
14. These codes, one from each subcategory, are needed to complete the scale. The 7th character indicates when the scale was recorded. The 7th character should match for all three codes.
15. At a minimum, report the initial score documented on presentation at your facility. This may be a score from the emergency medicine technician (EMT) or in the emergency department. If desired, a facility may choose to capture multiple coma scale scores. Assign code R40.24, Glasgow coma scale, total score, when only the total score is documented in the medical record and not the individual score(s).
    
    
16. Functional quadriplegia
17. Functional quadriplegia (code R53.2) is the lack of ability to use one’s limbs or to ambulate due to extreme debility. It is not associated with neurologic deficit or injury, and code R53.2 should not be used for cases of neurologic quadriplegia. It should only be assigned if functional quadriplegia is specifically documented in the medical record.
    
    
18. SIRS due to non-infectious process
19. NOTE
20. This guideline has been moved from Chapter 17: Injury and Poisoning (I-9).
21. The systemic inflammatory response syndrome (SIRS) can develop as a result of certain non-infectious disease processes, such as trauma, malignant neoplasm, or pancreatitis. When SIRS is documented with a noninfectious condition, and no subsequent infection is documented, the code for the underlying condition, such as an injury, should be assigned, followed by code R65.10, Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction, or code R65.11, Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction. If an associated acute organ dysfunction is documented, the appropriate code(s) for the specific type of organ dysfunction(s) should be assigned in addition to code R65.11. If acute organ dysfunction is documented, but it cannot be determined if the acute organ dysfunction is associated with SIRS or due to another condition (e.g., directly due to the trauma), the provider should be queried.
    
    
22. Death NOS
23. Code R99, Ill-defined and unknown cause of mortality, is only for use in the very limited circumstance when a patient who has already died is brought into an emergency department or other healthcare facility and is pronounced dead upon arrival. It does not represent the discharge disposition of death.

Remember:

• Symptom codes are not coded and reported when a confirmed diagnosis has been established by the provider.
• Chapter 18 contains many, but not all codes for symptoms.

As you can see, there have been several changes to the symptom chapter for I-10. In my personal opinion, organizing the symptoms in “blocks” under each specific body system, makes the information much easier to locate specific symptoms at-a-glance.

Resources:

ICD-9-CM Coding book by Ingenix ICD-10-CM Coding Book by Ingenix AHIMA ICD-10-CM Training Manual