ICD-10-CM codes for common conditions · CollegeCompass360 free study tools
For study only. Code titles and notes from the CMS FY 2027 ICD-10-CM (in effect October 1, 2026) code file and tabular list. Not medical advice.
Type a condition (anemia, CHF, sepsis), a code with or without the period (I50.9, j45), or a word from a code title (persistent, exacerbation). Each sheet shows the chapter, the category, the most-used codes with their exact FY 2027 titles, the Excludes, Code first and Code also notes that matter, and how a coder chooses between them. A coding reference for study only: nothing here is medical advice.
14 conditions, 151 codes, all from the FY 2027 code files.
Anemia
- Chapter
- 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
- Block
- Nutritional anemias (D50-D53) and Aplastic and other anemias and other bone marrow failure syndromes (D60-D64)
- Categories
- D50, D51, D52, D62, D63, D64
Anemia codes split by cause. The type the provider documents decides the category; a bare “anemia” lands on D64.9.
Most-used codes, exact titles
D64.9Go-to
Anemia, unspecified
The index default for “anemia” with no type.
D50.9
Iron deficiency anemia, unspecified
Iron deficiency with no cause stated.
D50.0
Iron deficiency anemia secondary to blood loss (chronic)
Chronic blood loss. Acute blood loss is D62, not here.
D50.8
Other iron deficiency anemias
The inclusion term names iron deficiency anemia due to inadequate dietary iron intake.
D62
Acute posthemorrhagic anemia
A three-character code with no further digits. Acute blood loss anemia, including after surgery.
D51.0
Vitamin B12 deficiency anemia due to intrinsic factor deficiency
Pernicious anemia indexes here.
D51.9
Vitamin B12 deficiency anemia, unspecified
D52.9
Folate deficiency anemia, unspecified
D63.1
Anemia in chronic kidney disease
A manifestation code: the CKD code (N18.-) is sequenced first.
D63.0
Anemia in neoplastic disease
Anemia caused by the cancer itself. The neoplasm is sequenced first.
D64.81
Anemia due to antineoplastic chemotherapy
Anemia caused by the treatment, not the tumor.
Notes that change the code
- Excludes1 at D50.0: acute posthemorrhagic anemia (D62)
- Excludes1 at D62: anemia due to chronic blood loss (D50.0)
- Excludes1 at D62: blood loss anemia NOS (D50.0)
- Code first at D63.1: underlying chronic kidney disease (CKD) (N18.-)
- Code first at D63.0: neoplasm (C00-D49)
- Excludes2 at D63.0: anemia due to antineoplastic chemotherapy (D64.81)
- Excludes1 at D53.9: anemia NOS (D64.9)
How a coder chooses
- 1Is a type documented? None: D64.9. A type: go to its category (iron D50, B12 D51, folate D52).
- 2Iron deficiency: is a cause documented? Chronic blood loss: D50.0. Dietary: D50.8. No cause: D50.9.
- 3“Acute blood loss anemia” (often after surgery) is D62, outside the iron-deficiency category. The two Excludes1 notes keep D50.0 and D62 apart: chronic goes to D50.0, acute to D62.
- 4Anemia “in” or “due to” a chronic disease is a D63 manifestation code, sequenced after the disease it belongs to (N18.- first for CKD, the neoplasm first for D63.0). Anemia from chemotherapy is D64.81, and the guideline (I.C.2.c.2) puts the anemia first when the visit is only for the anemia.
Hypertension
- Chapter
- 9: Diseases of the circulatory system (I00-I99)
- Block
- Hypertensive diseases (I10-I1A)
- Categories
- I10, I11, I12, I13, I16
Plain hypertension is one code, I10. Hypertension together with heart failure or chronic kidney disease moves to a combination code, because the classification presumes the link.
Most-used codes, exact titles
I10Go-to
Essential (primary) hypertension
Three characters, no decimal. Includes “high blood pressure”.
I11.0
Hypertensive heart disease with heart failure
Add an I50.- code for the type of heart failure.
I11.9
Hypertensive heart disease without heart failure
I12.9
Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
Add N18.1-N18.4 or N18.9 for the stage.
I12.0
Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
Add N18.5 or N18.6.
I13.0
Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
Hypertension + heart failure + CKD 1-4. Add I50.- and N18.-.
I13.10
Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.2
Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I16.0
Hypertensive urgency
Code also the hypertension itself (I10-I15, I1A).
I16.1
I16.9
Hypertensive crisis, unspecified
R03.0
Elevated blood-pressure reading, without diagnosis of hypertension
A reading is not a diagnosis (guideline I.C.9.a.7).
Notes that change the code
- Use additional code at I10-I1A: code to identify: exposure to environmental tobacco smoke (Z77.22); history of tobacco dependence (Z87.891); occupational exposure to environmental tobacco smoke (Z57.31); tobacco dependence (F17.-); tobacco use (Z72.0)
- Excludes1 at I10: hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16)
- Includes at I11: any condition in I50.- or I51.4-I51.7, I51.89, I51.9 due to hypertension
- Use additional code at I11.0: code to identify type of heart failure (I50.-)
- Includes at I13: any condition in I11.- with any condition in I12.-
- Use additional code at I12.9: code to identify the stage of chronic kidney disease (N18.1-N18.4, N18.9)
- Code also at I16: any identified hypertensive disease (I10-I15, I1A)
How a coder chooses
- 1Hypertension alone: I10. The “with” convention (guideline I.A.15 and I.C.9.a) presumes a causal link between hypertension and heart failure, and between hypertension and CKD, even when the note never says “due to”. Only a provider statement that they are unrelated breaks the link.
- 2Hypertension + heart failure: I11.0 first, then the I50.- code for the type. Hypertension + CKD: I12.0 or I12.9 by stage, then N18.-. All three: one I13 code, never I11 and I12 together (the Includes note at I13).
- 3Hypertensive urgency, emergency or crisis: I16.0, I16.1 or I16.9, and code also the hypertension (I10, or I11-I13 when heart or kidney disease is present).
- 4A high reading without an established diagnosis is R03.0, not I10.
Heart failure (CHF)
- Chapter
- 9: Diseases of the circulatory system (I00-I99)
- Block
- Other forms of heart disease (I30-I5A)
- Categories
- I50
Category I50 is built from two choices: the type (systolic, diastolic, combined) and the acuity (acute, chronic, acute on chronic). “CHF” on its own lands on I50.9.
Most-used codes, exact titles
I50.9Go-to
Heart failure, unspecified
Inclusion terms: Congestive heart failure NOS; Cardiac, heart or myocardial failure NOS.
I50.20
Unspecified systolic (congestive) heart failure
Inclusion term at I50.2: Heart failure with reduced ejection fraction [HFrEF].
I50.21
Acute systolic (congestive) heart failure
I50.22
Chronic systolic (congestive) heart failure
I50.23
Acute on chronic systolic (congestive) heart failure
I50.30
Unspecified diastolic (congestive) heart failure
Inclusion term at I50.3: Heart failure with preserved ejection fraction [HFpEF].
I50.32
Chronic diastolic (congestive) heart failure
I50.33
Acute on chronic diastolic (congestive) heart failure
I50.40
Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
I50.43
Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.1
Left ventricular failure, unspecified
I50.810
Right heart failure, unspecified
I50.82
Biventricular heart failure
Code also the type of left ventricular failure, if known.
I50.84
End stage heart failure
Inclusion term: Stage D heart failure. Code also the type (I50.2-I50.43).
Notes that change the code
- Code first at I50: heart failure due to hypertension (I11.0)
- Code first at I50: heart failure due to hypertension with chronic kidney disease (I13.-)
- Excludes2 at I50: cardiac arrest (I46.-)
- Inclusion term at I50.2: Heart failure with reduced ejection fraction [HFrEF]
- Inclusion term at I50.3: Heart failure with preserved ejection fraction [HFpEF]
- Excludes1 at I50.2 and I50.3: combined systolic (congestive) and diastolic (congestive) heart failure (I50.4-)
- Code also at I50.2, I50.3, I50.4: end stage heart failure, if applicable (I50.84)
- Code also at I50.84: the type of heart failure as systolic, diastolic, or combined, if known (I50.2-I50.43)
How a coder chooses
- 1Type first: systolic (or HFrEF) is I50.2-, diastolic (or HFpEF) is I50.3-, both is I50.4-. “Combined” has its own subcategory, so systolic and diastolic codes are never paired (Excludes1).
- 2Then the fifth character for acuity: 0 unspecified, 1 acute, 2 chronic, 3 acute on chronic.
- 3“CHF” or “heart failure” with no type: I50.9. Left-sided only: I50.1. Right-sided only: I50.81-. End stage: I50.84 plus the type.
- 4Hypertension in the same record: the Code first notes send the coder to I11.0 (or I13.-) ahead of the I50 code.
Atrial fibrillation
- Chapter
- 9: Diseases of the circulatory system (I00-I99)
- Block
- Other forms of heart disease (I30-I5A)
- Categories
- I48
One word in the note decides the code: paroxysmal, persistent, chronic or permanent. Flutter has its own codes in the same category.
Most-used codes, exact titles
I48.91Go-to
Unspecified atrial fibrillation
The index default for atrial fibrillation with no pattern named.
I48.0
Paroxysmal atrial fibrillation
I48.19
Other persistent atrial fibrillation
Inclusion terms: Persistent atrial fibrillation, NOS; Chronic persistent atrial fibrillation.
I48.11
Longstanding persistent atrial fibrillation
I48.20
Chronic atrial fibrillation, unspecified
“Chronic” alone.
I48.21
Permanent atrial fibrillation
I48.3
Typical atrial flutter
Inclusion term: Type I atrial flutter.
I48.4
Atypical atrial flutter
Inclusion term: Type II atrial flutter.
I48.92
Unspecified atrial flutter
Notes that change the code
- Excludes1 at I48.1: Permanent atrial fibrillation (I48.21)
- Excludes1 at I48.20: Chronic persistent atrial fibrillation (I48.19)
- Inclusion term at I48.19: Persistent atrial fibrillation, NOS
How a coder chooses
- 1Find the pattern word. Paroxysmal: I48.0. Persistent: I48.19 (longstanding persistent: I48.11). Permanent: I48.21. Chronic with nothing else: I48.20. No pattern word: I48.91.
- 2“Chronic persistent” goes to I48.19, not I48.20 (the Excludes1 at I48.20 says so).
- 3Flutter is coded separately: typical I48.3, atypical I48.4, unspecified I48.92. Fibrillation and flutter can both be reported when both are documented.
Osteoporosis
- Chapter
- 13: Diseases of the musculoskeletal system and connective tissue (M00-M99)
- Block
- Disorders of bone density and structure (M80-M85)
- Categories
- M80, M81 (and Z87.310)
Two categories: M81 when there is no current fracture, M80 when the osteoporosis has caused a fracture that is being treated now. Site only appears in M80, and it is the site of the fracture.
Most-used codes, exact titles
M81.0Go-to
Age-related osteoporosis without current pathological fracture
Inclusion terms: Osteoporosis NOS; Postmenopausal and Senile osteoporosis without current pathological fracture.
M81.8
Other osteoporosis without current pathological fracture
Drug-induced, idiopathic, of disuse, post-traumatic, and others named in the inclusion terms.
M81.6
Localized osteoporosis [Lequesne]
Z87.310
Personal history of (healed) osteoporosis fracture
Follows the M81 code when an old fracture has healed.
M80.00XA
Age-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
X is a placeholder so the 7th character lands in position 7.
M80.08XA
Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.051A
Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture
The inclusion term at M80.05 names the hip.
M80.052A
Age-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture
M80.00XD
Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with routine healing
M85.80
Other specified disorders of bone density and structure, unspecified site
Where the index sends “osteopenia” (M85.8-).
Notes that change the code
- Excludes1 at M81: osteoporosis with current pathological fracture (M80.-)
- Use additional code at M81: code to identify: major osseous defect, if applicable (M89.7-); personal history of (healed) osteoporosis fracture, if applicable (Z87.310)
- Includes at M80: osteoporosis with current fragility fracture
- Excludes1 at M80: pathological fracture NOS (M84.4)
- Excludes1 at M80: collapsed vertebra NOS (M48.5)
- Excludes2 at M80: personal history of (healed) osteoporosis fracture (Z87.310)
- 7th character at M80: A initial encounter for fracture; D subsequent encounter for fracture with routine healing; G subsequent encounter for fracture with delayed healing; K subsequent encounter for fracture with nonunion; P subsequent encounter for fracture with malunion; S sequela
How a coder chooses
- 1Is there a current fracture caused by the osteoporosis? No: M81.0 (age-related, postmenopausal, senile, or just “osteoporosis”) or M81.8 for the other types. Add Z87.310 for a healed earlier fracture (guideline I.C.13.d.1).
- 2Yes: M80. Pick the fracture site (4th-6th characters, with right/left where the site has sides), then the 7th character for the episode of care. The guideline (I.C.13.d.2) uses M80, not a traumatic fracture code, when a known osteoporosis patient breaks a bone in a fall that would not break healthy bone.
- 3Osteoporosis is systemic, so M81 carries no site. The site in M80 is where the fracture is.
- 4“Osteopenia” is not osteoporosis: the index sends it to M85.8-.
Asthma
- Chapter
- 10: Diseases of the respiratory system (J00-J99)
- Block
- Chronic lower respiratory diseases (J40-J4B)
- Categories
- J45
The fourth character is the severity the provider documented; the fifth (or sixth) is the state of the asthma at this visit: uncomplicated, with exacerbation, or with status asthmaticus.
Most-used codes, exact titles
J45.909Go-to
Unspecified asthma, uncomplicated
Inclusion term: Asthma NOS. The index default.
J45.901
Unspecified asthma with (acute) exacerbation
J45.902
Unspecified asthma with status asthmaticus
J45.20
Mild intermittent asthma, uncomplicated
J45.21
Mild intermittent asthma with (acute) exacerbation
J45.30
Mild persistent asthma, uncomplicated
J45.31
Mild persistent asthma with (acute) exacerbation
J45.40
Moderate persistent asthma, uncomplicated
J45.41
Moderate persistent asthma with (acute) exacerbation
J45.42
Moderate persistent asthma with status asthmaticus
J45.50
Severe persistent asthma, uncomplicated
J45.51
Severe persistent asthma with (acute) exacerbation
J45.52
Severe persistent asthma with status asthmaticus
J45.990
Exercise induced bronchospasm
J45.991
Notes that change the code
- Includes at J45: allergic rhinitis with asthma
- Includes at J45: hay fever with asthma
- Excludes1 at J45: wheezing NOS (R06.2)
- Excludes2 at J45: asthma with chronic obstructive pulmonary disease (J44.89)
- Excludes2 at J45: chronic obstructive asthma (J44.89)
- Includes at J44: asthma with chronic obstructive pulmonary disease
- Code also at J44: type of asthma, if applicable (J45.-)
- Use additional code at J45: code to identify: eosinophilic asthma (J82.83); exposure to environmental tobacco smoke (Z77.22); exposure to tobacco smoke in the perinatal period (P96.81); history of tobacco dependence (Z87.891); occupational exposure to environmental tobacco smoke (Z57.31); tobacco dependence (F17.-); tobacco use (Z72.0)
How a coder chooses
- 1Severity from the documentation: mild intermittent J45.2-, mild persistent J45.3-, moderate persistent J45.4-, severe persistent J45.5-. No severity: J45.90-.
- 2Then the last character: 1 with (acute) exacerbation, 2 with status asthmaticus, 0 uncomplicated. The unspecified subcategory is the odd one out: J45.901, J45.902 and J45.909 (uncomplicated ends in 9).
- 3Allergic rhinitis or hay fever with asthma is included in J45: the J45 code covers both (J30 has a matching Excludes1).
- 4Asthma with COPD indexes to J44.89: J44 includes it, and the Excludes2 at J45 points there. The Code also note at J44 adds a J45 code for the type of asthma when the provider documents one.
Pneumonia
- Chapter
- 10: Diseases of the respiratory system (J00-J99)
- Block
- Influenza and pneumonia (J09-J18)
- Categories
- J12, J13, J14, J15, J16, J18 (and J69.0)
The organism picks the category. No organism documented means J18; a named bacterium or virus means J13, J14, J15 or J12. Aspiration pneumonia lives in a different block, J69.
Most-used codes, exact titles
J18.9Go-to
Pneumonia, unspecified organism
The index default for “pneumonia”. “Community-acquired pneumonia” with no organism named lands here too.
J18.1
Lobar pneumonia, unspecified organism
J18.0
Bronchopneumonia, unspecified organism
J15.9
Unspecified bacterial pneumonia
“Bacterial pneumonia” with no organism named.
J13
Pneumonia due to Streptococcus pneumoniae
Pneumococcal pneumonia. Three characters, no decimal.
J15.211
Pneumonia due to Methicillin susceptible Staphylococcus aureus
Inclusion terms: MSSA pneumonia; Pneumonia due to Staphylococcus aureus NOS.
J15.212
Pneumonia due to Methicillin resistant Staphylococcus aureus
J12.9
Viral pneumonia, unspecified
J12.82
Pneumonia due to coronavirus disease 2019
Code first COVID-19 (U07.1).
J69.0
Pneumonitis due to inhalation of food and vomit
Inclusion term: Aspiration pneumonia NOS.
Notes that change the code
- Use additional code at J09-J18: code, if applicable, to identify resistance to antimicrobial drugs (Z16.-)
- Code first at J18: if applicable, associated influenza (J09.X1, J10.0-, J11.0-)
- Excludes2 at J18: aspiration pneumonia NOS (J69.0)
- Excludes1 at J13: lobar pneumonia, unspecified organism (J18.1)
- Excludes1 at J15: Legionnaires' disease (A48.1)
- Code first at J12.82: COVID-19 (U07.1)
- Inclusion term at J69.0: Aspiration pneumonia NOS
How a coder chooses
- 1Is an organism documented? No: J18.-. “Bacterial” only: J15.9. “Viral” only: J12.9. A named organism: its own code (J13 pneumococcal, J15.211 MSSA, J15.212 MRSA, J15.0 Klebsiella, and so on).
- 2Lobar and broncho- wording only matters when the organism is unspecified: J18.1 and J18.0. Pneumococcal pneumonia is J13 even when the note says lobar (Excludes1 at J13).
- 3Aspiration pneumonia is J69.0, outside the pneumonia block. Influenza with pneumonia: the influenza code is sequenced first. COVID-19 pneumonia: U07.1 first, then J12.82.
- 4Pneumonia that is the source of sepsis: the sepsis code goes first and the pneumonia second when both are present on admission (guideline I.C.1.d.4).
Dementia
- Chapter
- 5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
- Block
- Mental disorders due to known physiological conditions (F01-F09)
- Categories
- F01, F02, F03 (and G30)
Dementia codes are built from the cause (vascular F01, another disease F02, unknown F03), the severity (unspecified, mild, moderate, severe) and the disturbance (none, behavioral, psychotic, mood, anxiety).
Most-used codes, exact titles
F03.90Go-to
Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
Inclusion term: Dementia NOS.
F03.A0
Unspecified dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F03.B0
Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F03.C0
Unspecified dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F03.911
Unspecified dementia, unspecified severity, with agitation
F03.918
Unspecified dementia, unspecified severity, with other behavioral disturbance
Add Z91.83 for wandering, if documented.
F03.92
Unspecified dementia, unspecified severity, with psychotic disturbance
F03.93
Unspecified dementia, unspecified severity, with mood disturbance
F03.94
Unspecified dementia, unspecified severity, with anxiety
G30.9
Alzheimer's disease, unspecified
Sequenced first; the F02 code follows. G30.0 early onset, G30.1 late onset.
F02.80
Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
A manifestation code: never first-listed.
F02.811
Dementia in other diseases classified elsewhere, unspecified severity, with agitation
F01.50
Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
Z91.83
Wandering in diseases classified elsewhere
Notes that change the code
- Code first at F02: the underlying physiological condition, such as: Alzheimer's (G30.-); Parkinson's disease (G20.-); neurocognitive disorder with Lewy bodies (G31.83); traumatic brain injury (S06.-)
- Excludes2 at F02: vascular dementia (F01.5-, F01.A-, F01.B-, F01.C-)
- Use additional code at G30: code, if applicable, to identify: dementia with behavioral disturbance (F02.81-, F02.A1-, F02.B1-, F02.C1-); dementia without behavioral disturbance (F02.80, F02.A0, F02.B0, F02.C0)
- Excludes1 at G30: senile dementia NOS (F03.-)
- Excludes2 at F03: dementia with delirium or acute confusional state (F05)
- Use additional code at F03.918: code, if applicable, to identify wandering in unspecified dementia (Z91.83)
- Code first at F01: if applicable, any causal condition
How a coder chooses
- 1Cause first. A named disease (Alzheimer’s, Parkinson’s, Lewy bodies): that disease code first, then F02.-. Vascular: F01.-. No cause: F03.-. F02 codes carry “in diseases classified elsewhere” in the title, so they are never the first-listed diagnosis (convention I.A.13).
- 2Severity is the fourth character (the first one after the decimal point) and comes only from the provider: 9 unspecified, A mild, B moderate, C severe (guideline I.C.5.d). Not documented means unspecified.
- 3Disturbance is the fifth character: 0 none, 1 behavioral (then a sixth: 1 agitation, 8 other behavioral), 2 psychotic, 3 mood, 4 anxiety.
- 4“Dementia” with nothing else: F03.90. Wandering adds Z91.83 after the dementia code.
Sepsis
- Chapter
- 1: Certain infectious and parasitic diseases (A00-B99)
- Block
- Other bacterial diseases (A30-A49)
- Categories
- A40, A41 (and R65.2, R78.81)
Sepsis is coded with the infection code for the organism (A41.9 when none is named). Severe sepsis adds a second code from R65.2, which is never sequenced first.
Most-used codes, exact titles
A41.9Go-to
Sepsis, unspecified organism
Inclusion term: Septicemia NOS. The code when no organism is documented.
A41.01
Sepsis due to Methicillin susceptible Staphylococcus aureus
Inclusion terms: MSSA sepsis; Staphylococcus aureus sepsis NOS.
A41.02
Sepsis due to Methicillin resistant Staphylococcus aureus
A41.51
Sepsis due to Escherichia coli [E. coli]
A41.50
Gram-negative sepsis, unspecified
A41.81
Sepsis due to Enterococcus
A40.3
Sepsis due to Streptococcus pneumoniae
Streptococcal sepsis is category A40, not A41.
A40.9
Streptococcal sepsis, unspecified
R65.20
Severe sepsis without septic shock
Only with documented severe sepsis or an associated acute organ dysfunction.
R65.21
Severe sepsis with septic shock
R78.81
Bacteremia
Bacteria in the blood is not sepsis.
Notes that change the code
- Excludes1 at A41: bacteremia NOS (R78.81)
- Excludes1 at A41: streptococcal sepsis (A40.-)
- Code first at A41: if applicable, postprocedural sepsis (T81.44-)
- Code first at R65.2: underlying infection, such as: sepsis NOS (A41.9)
- Use additional code at R65.2: code to identify specific acute organ dysfunction, such as: acute kidney failure (N17.-); acute respiratory failure (J96.0-); encephalopathy (metabolic) (septic) (G93.41); hepatic failure (K72.0-)
- Excludes1 at R65.21: postprocedural septic shock (T81.12-)
- Excludes1 at R78.81: sepsis-code to specified infection
How a coder chooses
- 1Start with the systemic infection code: the organism if documented (A41.01, A41.02, A41.51, A40.3, and so on), otherwise A41.9 (guideline I.C.1.d.1).
- 2Severe sepsis needs at least two codes: the infection first, then R65.20, or R65.21 with septic shock. Then a code for each acute organ dysfunction. Assign R65.2- only when severe sepsis or an organ dysfunction linked to the sepsis is documented; an unclear link means a query.
- 3Sepsis with a local infection such as pneumonia, both present on admission: sepsis first, the local infection second. A code from R65.2 can never be the principal diagnosis.
- 4“Urosepsis” has no code: the index says code to the condition, and the guideline says query the provider. Bacteremia on its own is R78.81, and A41 excludes it.
Prediabetes
- Chapter
- 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
- Block
- Abnormal findings on examination of blood, without diagnosis (R70-R79)
- Categories
- R73
Prediabetes is an R code, a finding without a diagnosis of diabetes. The whole category is excluded once diabetes (E08-E13) is diagnosed.
Most-used codes, exact titles
R73.03Go-to
Prediabetes
Inclusion term: Latent diabetes. The index entry for “prediabetes”.
R73.01
Impaired fasting glucose
Inclusion term: Elevated fasting glucose.
R73.02
Impaired glucose tolerance (oral)
R73.09
Other abnormal glucose
Inclusion terms: Abnormal glucose NOS; Abnormal non-fasting glucose tolerance.
R73.9
Hyperglycemia, unspecified
E11.9
Type 2 diabetes mellitus without complications
For contrast: once diabetes is documented, R73 is out.
Notes that change the code
- Excludes1 at R73: diabetes mellitus (E08-E13)
- Excludes1 at R73: diabetes mellitus in pregnancy, childbirth and the puerperium (O24.-)
- Excludes1 at R73.0: gestational diabetes (O24.4-)
- Excludes1 at R73.0: hypoglycemia (E16.2)
- Excludes1 at R73.0: glycosuria (R81)
- Excludes1 at R73.0: type 1 diabetes mellitus, presymptomatic (E10.A-)
How a coder chooses
- 1Code the words the provider used. “Prediabetes” (or latent or borderline diabetes): R73.03. “Impaired fasting glucose”: R73.01. “Impaired glucose tolerance”: R73.02.
- 2A lab finding with no named condition: R73.09 for abnormal glucose, R73.9 for hyperglycemia.
- 3Never turn a lab value into a diabetes code. Diabetes is coded only when the provider documents it, and then the R73 code is dropped (Excludes1).
Gout
- Chapter
- 13: Diseases of the musculoskeletal system and connective tissue (M00-M99)
- Block
- Inflammatory polyarthropathies (M05-M14)
- Categories
- M10, M1A
Gout has two categories: M10 for gout, acute gout, attacks and flares, and M1A for chronic gout, which carries a 7th character for tophi. Both take a cause and a joint.
Most-used codes, exact titles
M10.9Go-to
Gout, unspecified
The index default: gout, acute, attack, flare.
M10.00
Idiopathic gout, unspecified site
Inclusion terms at M10.0: Gouty bursitis; Primary gout.
M10.071
Idiopathic gout, right ankle and foot
M10.072
Idiopathic gout, left ankle and foot
M10.079
Idiopathic gout, unspecified ankle and foot
M10.30
Gout due to renal impairment, unspecified site
M10.40
Other secondary gout, unspecified site
M1A.9XX0
Chronic gout, unspecified, without tophus (tophi)
Two X placeholders fill the code to seven characters.
M1A.9XX1
Chronic gout, unspecified, with tophus (tophi)
M1A.00X0
Idiopathic chronic gout, unspecified site, without tophus (tophi)
Notes that change the code
- Inclusion term at M10: Acute gout; Gout attack; Gout flare; Podagra
- Excludes2 at M10: chronic gout (M1A.-)
- Excludes1 at M1A: gout NOS (M10.-)
- Excludes2 at M1A: acute gout (M10.-)
- 7th character at M1A: 0 without tophus (tophi); 1 with tophus (tophi)
- Use additional code at M10.2 and M1A.2: code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
How a coder chooses
- 1Chronic or not? “Chronic gout” is M1A, everything else (gout, acute, flare, attack) is M10. “Gout” with nothing else is M10.9, which carries no site: the joint is coded only through a cause subcategory, and primary gout indexes to idiopathic (M10.0-).
- 2Cause, the fourth character: 0 idiopathic or primary, 1 lead-induced, 2 drug-induced, 3 due to renal impairment, 4 other secondary, 9 unspecified.
- 3Joint and side, the fifth and sixth characters: 1 shoulder, 2 elbow, 3 wrist, 4 hand, 5 hip, 6 knee, 7 ankle and foot, 8 vertebrae, 9 multiple sites; then 1 right, 2 left, 9 unspecified (vertebrae and multiple sites carry no side). Unspecified site is 0.
- 4M1A only: the 7th character, 0 without tophi or 1 with tophi, with X placeholders where the code is shorter than six characters.
Osteoarthritis
- Chapter
- 13: Diseases of the musculoskeletal system and connective tissue (M00-M99)
- Block
- Osteoarthritis (M15-M19)
- Categories
- M15, M16, M17, M18, M19
The joint picks the category: hip M16, knee M17, the thumb base M18, other single joints M19, many joints M15. Then type (primary, post-traumatic, secondary) and side.
Most-used codes, exact titles
M19.90Go-to
Unspecified osteoarthritis, unspecified site
Inclusion terms: Osteoarthritis NOS; Arthrosis NOS; Arthritis NOS.
M17.9
Osteoarthritis of knee, unspecified
The index default for osteoarthritis of the knee.
M17.0
Bilateral primary osteoarthritis of knee
M17.11
Unilateral primary osteoarthritis, right knee
M17.12
Unilateral primary osteoarthritis, left knee
M17.10
Unilateral primary osteoarthritis, unspecified knee
M16.9
Osteoarthritis of hip, unspecified
M16.0
Bilateral primary osteoarthritis of hip
M16.11
Unilateral primary osteoarthritis, right hip
M16.12
Unilateral primary osteoarthritis, left hip
M15.9
Polyosteoarthritis, unspecified
Inclusion term: Generalized osteoarthritis NOS.
M15.0
Primary generalized (osteo)arthritis
M19.011
Primary osteoarthritis, right shoulder
Other joints follow the same site-and-side pattern in M19.0-.
M18.11
Unilateral primary osteoarthritis of first carpometacarpal joint, right hand
Notes that change the code
- Excludes2 at M15-M19: osteoarthritis of spine (M47.-)
- Excludes1 at M15: bilateral involvement of single joint (M16-M19)
- Excludes1 at M19: polyarthritis (M15.-)
- Excludes2 at M19.04: primary osteoarthritis of first carpometacarpal joint (M18.0-, M18.1-)
- Inclusion term at M17.1: Primary osteoarthritis of knee NOS
How a coder chooses
- 1Which joint? Knee M17, hip M16, first carpometacarpal (thumb base) M18, other joints M19.0-/.1-/.2- by site, more than one joint M15, spine M47.- (another block).
- 2Which type? Primary, post-traumatic, secondary (or due to hip dysplasia for M16). No type: the unspecified code for that joint, such as M17.9.
- 3Which side? Both knees is one code, M17.0, not two. One knee takes 1 right, 2 left, 0 unspecified.
- 4Many joints: M15, and M15 excludes a single joint on both sides (that is M16-M19). “Osteoarthritis” with no joint: M19.90.
Allergic rhinitis
- Chapter
- 10: Diseases of the respiratory system (J00-J99)
- Block
- Other diseases of upper respiratory tract (J30-J39)
- Categories
- J30
The trigger decides the fourth and fifth characters: pollen, another seasonal cause, animal dander, food, or none named.
Most-used codes, exact titles
J30.9Go-to
Allergic rhinitis, unspecified
The index default for “rhinitis, allergic”.
J30.1
Allergic rhinitis due to pollen
Inclusion terms: Hay fever; Pollinosis; Allergy NOS due to pollen.
J30.2
Other seasonal allergic rhinitis
J30.81
Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89
Other allergic rhinitis
Inclusion term: Perennial allergic rhinitis.
J30.5
Allergic rhinitis due to food
J30.0
Vasomotor rhinitis
Not allergic, but in the same category.
J31.0
Chronic rhinitis
Where “rhinitis” with no “allergic” lands.
Notes that change the code
- Excludes1 at J30: allergic rhinitis with asthma (bronchial) (J45.909)
- Excludes1 at J30: rhinitis NOS (J31.0)
- Includes at J30: spasmodic rhinorrhea
How a coder chooses
- 1Is a trigger documented? Pollen or hay fever: J30.1. Another seasonal cause: J30.2. Cat or dog dander: J30.81. Food: J30.5. Year-round (perennial): J30.89. None: J30.9.
- 2“Rhinitis” without the word allergic is J31.0, and J30 excludes it.
- 3Allergic rhinitis together with asthma: one J45 code covers both (J45 includes “allergic rhinitis with asthma”; J30 has the matching Excludes1).
Sleep apnea
- Chapter
- 6: Diseases of the nervous system (G00-G99)
- Block
- Episodic and paroxysmal disorders (G40-G47)
- Categories
- G47.3
Obstructive, central or unspecified. The word “sleep” matters: apnea without it is a symptom code in chapter 18.
Most-used codes, exact titles
G47.33Go-to
Obstructive sleep apnea (adult) (pediatric)
Inclusion term: Obstructive sleep apnea hypopnea.
G47.30
Sleep apnea, unspecified
Inclusion term: Sleep apnea NOS.
G47.31
Primary central sleep apnea
Inclusion term: Idiopathic central sleep apnea.
G47.37
Central sleep apnea in conditions classified elsewhere
Code first the underlying condition.
G47.34
Idiopathic sleep related nonobstructive alveolar hypoventilation
G47.39
R06.81
Apnea, not elsewhere classified
Where “apnea” without “sleep” lands.
Notes that change the code
- Excludes1 at G47.3: apnea NOS (R06.81)
- Excludes1 at G47.3: sleep apnea of newborn (P28.3-)
- Code also at G47.3: any associated underlying condition
- Code first at G47.37: underlying condition
How a coder chooses
- 1Obstructive: G47.33. Central: G47.31 when primary, G47.37 when it is due to another condition, which is coded first.
- 2“Sleep apnea” with no type: G47.30. “Apnea” with no “sleep”: R06.81, which G47.3 excludes.
- 3The Code also note at G47.3 asks for any associated underlying condition the provider documents.