This month, we present a couple of code categories that will become familiar to ICU doctors. This includes some of the codes for respiratory failure and for sepsis.
While you can find additional codes in the ICD-10-CM Official Guidelines for Coding and Reporting available at http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html that are pertinent to critical care medicine, these codes also serve to reiterate a couple of points. First, in the J96 codes for respiratory failure, you see a number of “Excludes1” codes. Remember that this means that a J96 category code MAY NOT be used if you have also chosen one of the excludes1 codes.
A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form vs. an acquired form of the same condition.
In the R65 category with the SIRS/Sepsis codes, you will notice the “code first” direction. This instructs the coder to use another code describing the cause of the SIRS/Sepsis prior to using a R65 category code. In addition, there is a “code also” direction, which instructs the coder to add a code for any associated organ dysfunction. These instructions enhance the specificity of the coding process.
