ICD-10-CM 2018: The Complete Official Codebook

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Acknowledgments
Lauri Gray, RHIT, CPC, AHIMA-approved ICD-10-CM/PCS
Trainer Product Manager
Karen Schmidt, BSN, Technical Director
Anita Schmidt, BS, RHIT, AHIMA-approved ICD-10-CM/PCS
Trainer, Clinical Technical Editor
Leanne Patterson, CPC, Clinical Technical Editor
Anne Kenney, BA, MBA, CCA, CCS, Clinical Technical Editor
Karen Krawzik, RHIT, CCS, AHIMA-approved ICD-10-CM/PCS
Trainer, Clinical Technical Editor
Peggy Willard, CCS, AHIMA-approved ICD-10-CM/PCS Trainer,
Clinical Technical Editor
Dr. Vikas Kumar, BHMS, CPC, CPC-H, Clinical Technical Editor
Stacy Perry, Manager, Desktop Publishing
Lisa Singley, Project Manager
Tracy Betzler, Senior Desktop Publishing Specialist
Hope M. Dunn, Senior Desktop Publishing Specialist

3
 Katie Russell, Desktop Publishing Specialist
Kate Holden, Editor

Copyright
Property of Optum360, LLC. Optum360 and the Optum360 logo are
trademarks of Optum360, LLC. All other brand or product names are
trademarks or registered trademarks of their respective owner.
© 2017 Optum360, LLC. All rights reserved.
Made in the USA
OP201418/BQ44

Anita Schmidt, BS, RHIT, AHIMA-approved ICD-10-CM/PCS Trainer

Ms. Schmidt has expertise in Level I Adult and Pediatric Trauma
hospital coding, specializing in ICD-9-CM, ICD-10-CM/PCS, DRG,
and CPT coding. Her experience includes analysis of medical record
documentation, assignment of ICD-10-CM and PCS codes, DRG
validation, as well as CPT code assignments for same-day surgery cases.
She has conducted coding training and auditing, including DRG
validation, conducted electronic health record training, and worked with
clinical documentation specialists to identify documentation needs and
potential areas for physician education. Most recently she has been
developing content for resource and educational products related to
ICD-10-CM and ICD-10-PCS. Ms. Schmidt is an AHIMA-approved
ICD-10-CM/PCS trainer, and is an active member of the American
Health Information Management Association (AHIMA) and the
Minnesota Health Information Management Association (MHIMA).

Leanne Patterson, CPC

Ms. Patterson has more than 10 years of experience in the health care
profession. She has an extensive background in professional component
coding, with expertise in E/M coding and auditing, and HIPAA
compliance. Her experience includes general surgery coding, serving as
director of compliance, conducting chart-to-claim audits and physician
education. She has been responsible for coding and denial management
in large multispecialty physician practices, and most recently served as a
practice manager where she supervised implementation of a new EHR
system. Ms. Patterson is credentialed by the American Academy of
Professional Coders (AAPC) as a Certified Professional Coder (CPC).

4
5
Contents

Preface
ICD-10-CM Official Preface
Characteristics of ICD-10-CM

What’s New for 2018

Official Updates

Introduction
History of ICD-10-CM

How to Use ICD-10-CM: The Complete Official Codebook 2018

Use of Official Sources
Steps to Correct Coding
Organization
Introduction
Official ICD-10-CM Conventions and Guidelines
Alphabetic Index to Diseases
Neoplasm Table
Table of Drugs and Chemicals
Index to External Causes
Tabular List of Diseases
Appendixes
Illustrations

Overview of ICD-10-CM Official Conventions

Format
Punctuation
Abbreviations
NEC
NOS
Typeface
General Notes
Includes Notes
Inclusion Terms
Excludes Notes
Note
Default Codes
Syndromes
And
With

6
 See and See Also
Instructional Notes Used in the Tabular List
Code Assignment and Clinical Criteria

Additional Annotations
Code-Level Notations
Italics
Color Coding/Symbols
Other Code-Level Notations
Chapter-Level Notations
Chapter-Specific Guidelines with Coding Examples
Muscle and Tendon Table
Index Notations
Following References

ICD-10-CM Official Guidelines for Coding and Reporting

ICD-10-CM Index to Diseases and Injuries

ICD-10-CM Neoplasm Table

ICD-10-CM Table of Drugs and Chemicals

ICD-10-CM Index to External Causes

ICD-10-CM Tabular List of Diseases and Injuries

Chapter 1. Certain Infectious and Parasitic Diseases (A00-B99)
Chapter 2. Neoplasms (C00-D49)
Chapter 3. Diseases of the Blood and Blood-forming Organs and Certain Disorders
Involving the Immune Mechanism (D50–D89)
Chapter 4. Endocrine, Nutritional and Metabolic Diseases (E00-E89)
Chapter 5. Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99)
Chapter 6. Diseases of the Nervous System (G00-G99)
Chapter 7. Diseases of the Eye and Adnexa (H00-H59)
Chapter 8. Diseases of the Ear and Mastoid Process (H60-H95)
Chapter 9. Diseases of the Circulatory System (100-199)
Chapter 10. Diseases of the Respiratory System (J00-J99)
Chapter 11. Diseases of the Digestive System (K00-K95)
Chapter 12. Diseases of the Skin and Subcutaneous Tissue (L00-L99)
Chapter 13. Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
Chapter 14. Diseases of the Genitourinary System (N00-N99)
Chapter 15. Pregnancy, Childbirth, and the Puerperium (O00-O9A)
Chapter 16. Certain Conditions Originating in the Perinatal Period (P00-P96)
Chapter 17. Congenital Malformations, Deformations and Chromosomal Abnormalities
(Q00-Q99)

7
 Chapter 18. Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not
Elsewhere Classified (R00-R99)
Chapter 19. Injury, Poisoning and Certain Other Consequences of External Causes (S00-
T88)
Chapter 20. External Causes of Morbidity (V00-Y99)
Chapter 21. Factors Influencing Health Status and Contact With Health Services (Z00-
Z99)

Appendixes
Appendix A: 10 Steps to Correct Coding
Appendix B: Valid 3-character ICD-10-CM Codes
Appendix C: Pharmacology List 2018
Appendix D: Z Codes for Long-Term Drug Use with Associated Drugs
Appendix E: Z Codes Only as Principal/First-Listed Diagnosis
Appendix F: Centers for Medicare & Medicaid Services Hierarchical Condition Categories
(CMS-HCC)

Illustrations
Chapter 3. Diseases of the Blood and Blood-forming Organs and Certain Disorders
Involving the Immune Mechanism (D50–D89)
Red Blood Cells
White Blood Cell
Platelet
Coagulation
Spleen Anatomical Location and External Structures
Spleen Interior Structures
Chapter 4. Endocrine, Nutritional and Metabolic Diseases (E00–E89)
Endocrine System
Thyroid
Thyroid and Parathyroid Glands
Pancreas
Anatomy of the Adrenal Gland
Structure of an Ovary
Testis and Associated Structures
Thymus
Chapter 6. Diseases of the Nervous System (G00–G99)
Brain
Cranial Nerves
Peripheral Nervous System
Spinal Cord and Spinal Nerves
Nerve Cell
Chapter 7. Diseases of the Eye and Adnexa (H00–H59)
Eye
Posterior Pole of Globe/Flow of Aqueous Humor
Lacrimal System
Eye Musculature
Eyelid Structures

8
Chapter 8. Diseases of the Ear and Mastoid Process (H60–H95)
Ear Anatomy
Chapter 9. Diseases of the Circulatory System (100–199)
Anatomy of the Heart
Heart Cross Section
Heart Valves
Heart Conduction System
Coronary Arteries
Arteries
Veins
Internal Carotid and Vertebral Arteriesand Branches
External Carotid Artery and Branches
Branches of Abdominal Aorta
Portal Venous Circulation
Lymphatic System
Axillary Lymph Nodes
Lymphatic System of Head and Neck
Lymphatic Capillaries
Lymphatic Drainage
Chapter 10. Diseases of the Respiratory System (J00–J99)
Respiratory System
Upper Respiratory System
Lower Respiratory System
Paranasal Sinuses
Lung Segments
Alveoli
Chapter 11. Diseases of the Digestive System (K00–K95)
Digestive System
Omentum and Mesentery
Peritoneum and Retroperitoneum
Chapter 12. Diseases of the Skin and Subcutaneous Tissue (L00–L99)
Nail Anatomy
Skin and Subcutaneous Tissue
Chapter 13. Diseases of the Musculoskeletal System and Connective Tissue (M00–M99)
Bones and Joints
Shoulder Anterior View
Shoulder Posterior View
Elbow Anterior View
Elbow Posterior View
Hand
Hip Anterior View
Hip Posterior View
Knee Anterior View
Knee Posterior View
Foot
Muscles
Chapter 14. Diseases of the Genitourinary System (N00–N99)
Urinary System
Male Genitourinary System

9
 Female Internal Genitalia
Female Genitourinary Tract Lateral View
Chapter 15. Pregnancy, Childbirth, and the Puerperium (O00–O9A)
Term Pregnancy – Single Gestation
Twin Gestation–Dichorionic– Diamniotic (DI-DI)
Twin Gestation–Monochorionic–Diamniotic (MO-DI)
Twin Gestation–Monochorionic–Monoamniotic (MO-MO)
Chapter 19. Injury, Poisoning and Certain Other Consequences of External Causes (S00-
T88)
Types of Fractures
Salter-Harris Fracture Types

10
Preface

ICD-10-CM Official Preface

This FY 2018 update of the International Statistical Classification of Diseases
and Related Health Problems, 10th revision, Clinical Modification (ICD-10-
CM) is being published by the United States government in recognition of its
responsibility to promulgate this classification throughout the United States
for morbidity coding. The International Statistical Classification of Diseases
and Related Health Problems, 10th Revision (ICD-10), published by the
World Health Organization (WHO), is the foundation of ICD-10-CM.
ICD-10 continues to be the classification used in cause-of-death coding in
the United States. The ICD-10-CM is comparable with the ICD-10. The
WHO Collaborating Center for the Family of International Classifications in
North America, housed at the Centers for Disease Control and Prevention’s
National Center for Health Statistics (NCHS), has responsibility for the
implementation of ICD and other WHO-FIC classifications and serves as a
liaison with the WHO, fulfilling international obligations for comparable
classifications and the national health data needs of the United States. The
historical background of ICD and ICD-10 can be found in the Introduction
to the International Classification of Diseases and Related Health Problems
(ICD-10), 2010, World Health Organization, Geneva, Switzerland.

ICD-10-CM is the United States’ clinical modification of the World Health

Organization’s ICD-10. The term “clinical” is used to emphasize the
modification’s intent: to serve as a useful tool in the area of classification of
morbidity data for indexing of health records, medical care review, and
ambulatory and other health care programs, as well as for basic health
statistics. To describe the clinical picture of the patient the codes must be
more precise than those needed only for statistical groupings and trend
analysis.

Characteristics of ICD-10-CM
ICD-10-CM far exceeds its predecessors in the number of concepts and
codes provided. The disease classification has been expanded to include
health-related conditions and to provide greater specificity at the sixth and
seventh character level. The sixth and seventh characters are not optional and

11
are intended for use in recording the information documented in the clinical
record.

ICD-10-CM extensions, interpretations, modifications, addenda, or errata

other than those approved by the Centers for Disease Control and Prevention
are not to be considered official and should not be utilized. Continuous
maintenance of the ICD-10-CM is the responsibility of the aforementioned
agencies. However, because the ICD-10-CM represents the best in
contemporary thinking of clinicians, nosologists, epidemiologists, and
statisticians from both public and private sectors, when future modifications
are considered, advice will be sought from all stakeholders.

All official authorized addenda since the last complete update (October 1,
2017) have been included in this revision. For more detailed information
please see the complete official authorized addenda to ICD-10-CM,
including the “ICD-10-CM Official Guidelines for Coding and Reporting,”
and a description of the ICD-10-CM updating and maintenance process.

12
What’s New for 2018

Official Updates
The National Center for Health Statistics (NCHS), a section of the Centers
for Disease Control and Prevention (CDC), is the agency charged with
maintaining and updating ICD-10-CM. The 2018 official addendum was
posted to the Centers for Medicare and Medicaid Services (CMS) website on
June 13, 2017, identifying the changes to the ICD-10-CM code set for fiscal
2018. A summary of changes is provided below:
• 360 new codes added
• 226 code descri ptions revised
• 34 codes changed from valid to invalid

Note: Validity changes are the result of new codes being added to the
classification, changing a previously valid code to an invalid code, creating a
new subcategory.
A04.7 Enterocolitis due to Clostridium difficile
C96.2 Malignant mast cell tumor
D47.0 Histiocytic and mast cell tumors of uncertain behavior
E85.8 Other amyloidosis
H54.0 Blindness, both eyes
H54.11 Blindness, right eye, low vision left eye
H54.12 Blindness, left eye, low vision right eye
H54.2 Low vision, both eyes
H54.41 Blindness, right eye, normal vision left eye
H54.42 Blindness, left eye, normal vision right eye
H54.51 Low vision, right eye, normal vision left eye
H54.52 Low vision, left eye, normal vision right eye
I27.2 Other secondary pulmonary hypertension
K06.0 Gingival recession
K56.5 Intestinal adhesions [bands] with obstruction (postprocedural) (postinfection)
K56.60 Unspecified intestinal obstruction
K56.69 Other intestinal obstruction
K91.3 Postprocedural intestinal obstruction
M48.06 Spinal stenosis, lumbar region
N63 Unspecified lump in breast
O00.10 Tubal pregnancy without intrauterine pregnancy
O00.11 Tubal pregnancy with intrauterine pregnancy
O00.20 Ovarian pregnancy without intrauterine pregnancy
O00.21 Ovarian pregnancy with intrauterine pregnancy
P29.3 Persistent fetal circulation
P83.8 Other specified conditions of integument specific to newborn
P91.8 Other specified disturbances of cerebral status of newborn
Q53.11 Abdominal testis, unilateral
Q53.21 Abdominal testis, bilateral

13
 T07 Unspecified multiple injuries
T14.8 Other injury of unspecified body region
T14.90 Injury, unspecified
T14.91 Suicide attempt
Z36 Encounter for antenatal screening of mother

• 122 codes deleted from the classification

S06.1X7D Traumatic cerebral edema with loss of consciousness of any duration with death due to brain injury prior to
regaining consciousness, subsequent encounter
S06.1X7S Traumatic cerebral edema with loss of consciousness of any duration with death due to brain injury prior to
regaining consciousness, sequela
S06.1X8D Traumatic cerebral edema with loss of consciousness of any duration with death due to other cause prior to
regaining consciousness, subsequent encounter
S06.1X8S Traumatic cerebral edema with loss of consciousness of any duration with death due to other cause prior to
regaining consciousness, sequela
S06.2X7D Diffuse traumatic brain injury with loss of consciousness of any duration with death due to brain injury
prior to regaining consciousness, subsequent encounter
S06.2X7S Diffuse traumatic brain injury with loss of consciousness of any duration with death due to brain injury
prior to regaining consciousness, sequela
S06.2X8D Diffuse traumatic brain injury with loss of consciousness of any duration with death due to other cause
prior to regaining consciousness, subsequent encounter
S06.2X8S Diffuse traumatic brain injury with loss of consciousness of any duration with death due to other cause
prior to regaining consciousness, sequela
S06.307D Unspecified focal traumatic brain injury with loss of consciousness of any duration with death due to brain
injury prior to regaining consciousness, subsequent encounter
S06.307S Unspecified focal traumatic brain injury with loss of consciousness of any duration with death due to brain
injury prior to regaining consciousness, sequela
S06.308D Unspecified focal traumatic brain injury with loss of consciousness of any duration with death due to other
cause prior to regaining consciousness, subsequent encounter
S06.308S Unspecified focal traumatic brain injury with loss of consciousness of any duration with death due to other
cause prior to regaining consciousness, sequela
S06.317D Contusion and laceration of right cerebrum with loss of consciousness of any duration with death due to
brain injury prior to regaining consciousness, subsequent encounter
S06.317S Contusion and laceration of right cerebrum with loss of consciousness of any duration with death due to
brain injury prior to regaining consciousness, sequela
S06.318D Contusion and laceration of right cerebrum with loss of consciousness of any duration with death due to
other cause prior to regaining consciousness, subsequent encounter
S06.318S Contusion and laceration of right cerebrum with loss of consciousness of any duration with death due to
other cause prior to regaining consciousness, sequela
S06.327D Contusion and laceration of left cerebrum with loss of consciousness of any duration with death due to
brain injury prior to regaining consciousness, subsequent encounter
S06.327S Contusion and laceration of left cerebrum with loss of consciousness of any duration with death due to
brain injury prior to regaining consciousness, sequela
S06.328D Contusion and laceration of left cerebrum with loss of consciousness of any duration with death due to
other cause prior to regaining consciousness, subsequent encounter
S06.328S Contusion and laceration of left cerebrum with loss of consciousness of any duration with death due to
other cause prior to regaining consciousness, sequela
S06.337D Contusion and laceration of cerebrum, unspecified, with loss of consciousness of any duration with death
due to brain injury prior to regaining consciousness, subsequent encounter
S06.337S Contusion and laceration of cerebrum, unspecified, with loss of consciousness of any duration with death
due to brain injury prior to regaining consciousness, sequela
S06.338D Contusion and laceration of cerebrum, unspecified, with loss of consciousness of any duration with death
due to other cause prior to regaining consciousness, subsequent encounter
S06.338S Contusion and laceration of cerebrum, unspecified, with loss of consciousness of any duration with death
due to other cause prior to regaining consciousness, sequela
S06.347D Traumatic hemorrhage of right cerebrum with loss of consciousness of any duration with death due to
brain injury prior to regaining consciousness, subsequent encounter
S06.347S Traumatic hemorrhage of right cerebrum with loss of consciousness of any duration with death due to
brain injury prior to regaining consciousness, sequela
S06.348D Traumatic hemorrhage of right cerebrum with loss of consciousness of any duration with death due to
other cause prior to regaining consciousness, subsequent encounter
S06.348S Traumatic hemorrhage of right cerebrum with loss of consciousness of any duration with death due to
other cause prior to regaining consciousness, sequela
S06.357D Traumatic hemorrhage of left cerebrum with loss of consciousness of any duration with death due to brain
injury prior to regaining consciousness, subsequent encounter
S06.357S Traumatic hemorrhage of left cerebrum with loss of consciousness of any duration with death due to brain
injury prior to regaining consciousness, sequela
S06.358D Traumatic hemorrhage of left cerebrum with loss of consciousness of any duration with death due to other
cause prior to regaining consciousness, subsequent encounter
S06.358S Traumatic hemorrhage of left cerebrum with loss of consciousness of any duration with death due to other

14
 cause prior to regaining consciousness, sequela
S06.367D Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of any duration with death due
to brain injury prior to regaining consciousness, subsequent encounter
S06.367S Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of any duration with death due
to brain injury prior to regaining consciousness, sequela
S06.368D Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of any duration with death due
to other cause prior to regaining consciousness, subsequent encounter
S06.368S Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of any duration with death due
to other cause prior to regaining consciousness, sequela
S06.377D Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of any duration with death
due to brain injury prior to regaining consciousness, subsequent encounter
S06.377S Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of any duration with death
due to brain njury prior to regaining consciousness, sequela
S06.378D Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of any duration with death
due to other cause prior to regaining consciousness, subsequent encounter
S06.378S Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of any duration with death
due to other cause prior to regaining consciousness, sequela
S06.387D Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of any duration with death
due to brain njury prior to regaining consciousness, subsequent encounter
S06.387S Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of any duration with death
due to brain njury prior to regaining consciousness, sequela
S06.388D Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of any duration with death
due to other cause prior to regaining consciousness, subsequent encounter
S06.388S Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of any duration with death
due to other cause prior to regaining consciousness, sequela
S06.4X7D Epidural hemorrhage with loss of consciousness of any duration with death due to brain injury prior to
regaining consciousness, subsequent encounter
S06.4X7S Epidural hemorrhage with loss of consciousness of any duration with death due to brain injury prior to
regaining consciousness, sequela
S06.4X8D Epidural hemorrhage with loss of consciousness of any duration with death due to other causes prior to
regaining consciousness, subsequent encounter
S06.4X8S Epidural hemorrhage with loss of consciousness of any duration with death due to other causes prior to
regaining consciousness, sequela
S06.5X7D Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to brain injury
before regaining consciousness, subsequent encounter
S06.5X7S Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to brain injury
before regaining consciousness, sequela
S06.5X8D Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to other cause
before regaining consciousness, subsequent encounter
S06.5X8S Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to other cause
before regaining consciousness, sequela
S06.6X7D Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to brain
injury prior to regaining consciousness, subsequent encounter
S06.6X7S Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to brain
injury prior to regaining consciousness, sequela
S06.6X8D Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to other
cause prior to regaining consciousness, subsequent encounter
S06.6X8S Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to other
cause prior to regaining consciousness, sequela
S06.817D Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of
consciousness of any duration with death due to brain injury prior to regaining consciousness, subsequent
encounter
S06.817S Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of
consciousness of any duration with death due to brain injury prior to regaining consciousness, sequela
S06.818D Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of
consciousness of any duration with death due to other cause prior to regaining consciousness, subsequent
encounter
S06.818S Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of
consciousness of any duration with death due to other cause prior to regaining consciousness, sequela
S06.827D Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness
of any duration with death due to brain injury prior to regaining consciousness, subsequent encounter
S06.827S Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness
of any duration with death due to brain injury prior to regaining consciousness, sequela
S06.828D Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness
of any duration with death due to other cause prior to regaining consciousness, subsequent encounter
S06.828S Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness
of any duration with death due to other cause prior to regaining consciousness, sequela
S06.897D Other specified intracranial injury with loss of consciousness of any duration with death due to brain injury
prior to regaining consciousness, subsequent encounter
S06.897S Other specified intracranial injury with loss of consciousness of any duration with death due to brain injury
prior to regaining consciousness, sequela
S06.898D Other specified intracranial injury with loss of consciousness of any duration with death due to other cause

15
 prior to regaining consciousness, subsequent encounter
S06.898S Other specified intracranial injury with loss of consciousness of any duration with death due to other cause
prior to regaining consciousness, sequela
S06.9X7D Unspecified intracranial injury with loss of consciousness of any duration with death due to brain injury
prior to regaining consciousness, subsequent encounter
S06.9X7S Unspecified intracranial injury with loss of consciousness of any duration with death due to brain injury
prior to regaining consciousness, sequela
S06.9X8D Unspecified intracranial injury with loss of consciousness of any duration with death due to other cause
prior to regaining consciousness, subsequent encounter
S06.9X8S Unspecified intracranial injury with loss of consciousness of any duration with death due to other cause
prior to regaining consciousness, sequela
S63.13 Subluxation and dislocation of proximal interphalangeal joint of thumb
S63.131 Subluxation of proximal interphalangeal joint of right thumb
S63.131A Subluxation of proximal interphalangeal joint of right thumb, initial encounter
S63.131D Subluxation of proximal interphalangeal joint of right thumb, subsequent encounter
S63.131S Subluxation of proximal interphalangeal joint of right thumb, sequela
S63.132 Subluxation of proximal interphalangeal joint of left thumb
S63.132A Subluxation of proximal interphalangeal joint of left thumb, initial encounter
S63.132D Subluxation of proximal interphalangeal joint of left thumb, subsequent encounter
S63.132S Subluxation of proximal interphalangeal joint of left thumb, sequela
S63.133 Subluxation of proximal interphalangeal joint of unspecified thumb
S63.133A Subluxation of proximal interphalangeal joint of unspecified thumb, initial encounter
S63.133D Subluxation of proximal interphalangeal joint of unspecified thumb, subsequent encounter
S63.133S Subluxation of proximal interphalangeal joint of unspecified thumb, sequela
S63.134 Dislocation of proximal interphalangeal joint of right thumb
S63.134A Dislocation of proximal interphalangeal joint of right thumb, initial encounter
S63.134D Dislocation of proximal interphalangeal joint of right thumb, subsequent encounter
S63.134S Dislocation of proximal interphalangeal joint of right thumb, sequela
S63.135 Dislocation of proximal interphalangeal joint of left thumb
S63.135A Dislocation of proximal interphalangeal joint of left thumb, initial encounter
S63.135D Dislocation of proximal interphalangeal joint of left thumb, subsequent encounter
S63.135S Dislocation of proximal interphalangeal joint of left thumb, sequela
S63.136 Dislocation of proximal interphalangeal joint of unspecified thumb
S63.136A Dislocation of proximal interphalangeal joint of unspecified thumb, initial encounter
S63.136D Dislocation of proximal interphalangeal joint of unspecified thumb, subsequent encounter
S63.136S Dislocation of proximal interphalangeal joint of unspecified thumb, sequela
S63.14 Subluxation and dislocation of distal interphalangeal joint of thumb
S63.141 Subluxation of distal interphalangeal joint of right thumb
S63.141A Subluxation of distal interphalangeal joint of right thumb, initial encounter
S63.141D Subluxation of distal interphalangeal joint of right thumb, subsequent encounter
S63.141S Subluxation of distal interphalangeal joint of right thumb, sequela
S63.142 Subluxation of distal interphalangeal joint of left thumb
S63.142A Subluxation of distal interphalangeal joint of left thumb, initial encounter
S63.142D Subluxation of distal interphalangeal joint of left thumb, subsequent encounter
S63.142S Subluxation of distal interphalangeal joint of left thumb, sequela
S63.143 Subluxation of distal interphalangeal joint of unspecified thumb
S63.143A Subluxation of distal interphalangeal joint of unspecified thumb, initial encounter
S63.143D Subluxation of distal interphalangeal joint of unspecified thumb, subsequent encounter
S63.143S Subluxation of distal interphalangeal joint of unspecified thumb, sequela
S63.144 Dislocation of distal interphalangeal joint of right thumb
S63.144A Dislocation of distal interphalangeal joint of right thumb, initial encounter
S63.144D Dislocation of distal interphalangeal joint of right thumb, subsequent encounter
S63.144S Dislocation of distal interphalangeal joint of right thumb, sequela
S63.145 Dislocation of distal interphalangeal joint of left thumb
S63.145A Dislocation of distal interphalangeal joint of left thumb, initial encounter
S63.145D Dislocation of distal interphalangeal joint of left thumb, subsequent encounter
S63.145S Dislocation of distal interphalangeal joint of left thumb, sequela
S63.146 Dislocation of distal interphalangeal joint of unspecified thumb
S63.146A Dislocation of distal interphalangeal joint of unspecified thumb, initial encounter
S63.146D Dislocation of distal interphalangeal joint of unspecified thumb, subsequent encounter
S63.146S Dislocation of distal interphalangeal joint of unspecified thumb, sequela

16
17
Introduction

History of ICD-10-CM
The ICD-10-CM classification system was developed by the National Center
for Health Statistics (NCHS) as a clinical modification to the ICD-10 system
developed by the World Health Organization (WHO), primarily as a unique
system for use in the United States for morbidity and mortality reporting.
Although ICD-10 replaced ICD-9 for use in coding and classifying mortality
data from death certificates beginning January 1, 1999, ICD-10-CM
implementation was postponed many years until legislation to replace ICD-9-
CM, volumes 1 and 2, with ICD-10-CM was approved.

ICD-10 is the copyrighted product of the World Health Organization

(WHO), which has authorized the development of a clinical modification
(CM) of ICD-10 for use in the United States. However, all modifications to
the ICD-10 must conform to WHO conventions for ICD. The development
of ICD-10-CM included comprehensive evaluation by a Technical Advisory
Panel and extensive consultation with physician groups, clinical coders, and
other industry experts.

The ICD-10-CM draft and crosswalk between ICD-9-CM and ICD-10-

CM were made available on the Centers for Medicare and Medicaid Services
(CMS) website for public comment. The initial public comment period
extended from December 1997 through February 1998. A field test for ICD-
10-CM was conducted in the summer of 2003 jointly by the American
Hospital Association (AHA) and the American Health Information
Management Association (AHIMA). Public comments and suggestions were
reviewed and additional modifications to ICD-10-CM were made. Revisions
were made to ICD-10-CM based on the established update process for ICD-
10-CM (the ICD-10-CM Coordination and Maintenance Committee) and
the World Health Organization’s ICD-10 (the Update and Revision
Committee).

These revisions to ICD-10-CM have included:

• Information relevant to ambulatory and managed care encounters

18
• Expanded injury codes
• Creation of combination diagnosis/symptom codes to reduce the number
of codes needed to fully describe a condition
• The addition of 6th and 7th character classifications
• Incorporation of common 4th and 5th character classifications
• Classifications specific to laterality
• Classification refinement for increased data granularity

This new structure allows for further expansion than was possible with the
ICD-9-CM classification system.

The Department of Health and Human Services (HHS) published the final
rule regarding the adoption of both ICD-10-CM and ICD-10-PCS in the
January 16, 2009, Federal Register (45 CFR part 162 [CMS—0013—F]). The
initial compliance date for implementation of ICD-10-CM and ICD-10-
PCS as a replacement for ICD-9-CM was set at October 1, 2013. On April
17, 2012, the Department of Health and Human Services (HHS) released a
notice to postpone the date by which certain health care entities have to
comply with International Classification of Diseases, 10th Revision diagnosis
and procedure codes (ICD-10). The compliance date for implementation of
ICD-10-CM and ICD-10-PCS as a replacement for ICD-9-CM was
changed to October 1, 2014. On April 1, 2014, Congress enacted the
Protecting Access to Medicare Act of 2014, which contained a provision to
delay the implementation of ICD-10-CM/PCS by at least one year,
prohibiting the Department of Health and Human Services (HHS) from
adopting the ICD-10-CM/PCS code sets as the mandatory standard until
October 1, 2015. Eventually, the ICD-10-CM/PCS code sets were
implemented in entirety on October 1, 2015, and volumes 1 and 2 of ICD-9-
CM were retired.

ICD-10-CM: The Complete Official Code Set

ICD- 10-CM: The Complete Official Code Set 2018 edition includes many of
the enhancements described below in direct response to requests from our
subscribers. Users will find many of the conventions, icons, color bars, and
other enhancements familiar since many of these features are similar to the
hallmark color coding and symbols of our ICD-9-CM code books.

As you review the content, you will find the following:

19
• Exclusive feature — Check Placeholder Alert symbol, indicating the
need for one or more “filler” X character assignments in the 5th and/or
6th character position, in order to appropriately assign a required
character in the 7th character position
• Exclusive feature — Key word differentiation by the use of a green font
that highlights the differentiating terms in similar code descriptions in a
given category
• Exclusive color coding, symbols, and footnotes that alert coders to coding
and reimbursement issues, including the majority of the Medicare code
edits
• Exclusive feature — Exclusive following references and Check Additional
Character symbol in the indexes. The following references help coders
locate those alphanumeric codes that are out of sequence in the tabular
section.
• Exclusive feature — Exclusive shaded guides in the index that help users
easily follow the indent levels for the subterms under a main term
• Illustrations throughout the tabular list and at the back of the book that
feature anatomy and terminology included in the ICD-10-CM
classification system
• Exclusive feature — Detailed Muscle/Tendon tables that correspond to
codes in chapters 13 and 19
• The complete ICD-10-CM Official Guidelines for Coding and
Reporting, published by the U.S. Department of Health and Human
Services and approved by the cooperating parties (American Health
Information Management Association, National Center for Health
Statistics, Centers for Medicare and Medicaid Services, American
Hospital Association)
• Exclusive feature — Official chapter-specific guidelines with coding
examples at the beginning of each chapter
• All the official ICD-10-CM codes, indexes, notes, footnotes, and
symbols
• Icons and definitions to differentiate between the two types of Excludes
notes
• Check 4th, 5th, 6th, and 7th character symbols that identify codes that

20
 require the addition of a 4th, 5th, 6th, or 7th character for code
specificity and validity
• Color coding and symbol legend at the bottom of each page

Please review “How to Use ICD-10-CM: The Complete Official Codebook” in

this section to learn about the features that will help you assign and report
correct codes, ensuring appropriate reimbursement.

21
How to Use ICD-10-CM: The Complete Official
Codebook 2018

This International Classification of Diseases, 10th Revision, Clinical

Modification (ICD-10-CM) is being published by the United States
Government in recognition of its responsibility to promulgate this
classification throughout the United States for morbidity coding. This code
book represents an adaptation of ICD-10 that was created specifically for use
in the United States. Revisions to ICD-10-CM will be made based on the
established update process for ICD-10-CM (the ICD-10-CM Coordination
and Maintenance Committee) and the World Health Organization’s ICD-10
(the Update and Revision Committee).

Use of Official Sources

The ICD-10-CM: The Complete Official Codebook contains the official U.S.
Department of Health and Human Services, Tenth Revision, Clinical
Modification, ICD-10-CM codes, effective for the current year.

Much of the color coding and many of the symbols that identify coding and
reimbursement issues are derived from official federal government sources,
including the Integrated Outpatient Code Editor (IOCE), version 18.2.

For the most current IOCE documents please refer to the following:
https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs.html

Steps to Correct Coding

1. Before beginning to use this code book, review section I.A.,
“Conventions for the ICD-10-CM,” and section I.B., “General Coding
Guidelines,” of the ICD-10-CM Official Guidelines for Coding and
Reporting.
2. Look up the main term in the alphabetic index and scan the subterm
entries as appropriate. Review continued lines and additional subterms
that may appear in the next column or on the next page.

22
3. Note all parenthetical terms (nonessential modifiers) that help in code
selection but do not affect code assignment. Shaded vertical guidelines
in the index are provided to help determine the indentation level for
each subterm in relation to the main terms.
4. Pay close attention to the following instructions in the index:
– “See,” “see also,” and “see category” cross-references
– “With”/“without” notes
– “Omit code” notes
– “Due to” subterms
– Other instructions found in note boxes, such as “code by site”
– Following references and Check Additional Character symbol in the
indexes. The following references help coders locate those
alphanumeric codes that are out of sequence in the tabular section.
5. Do not code from the alphabetic index without verifying the accuracy of
the code in the tabular list. Locate the code in the alphanumerically
arranged tabular list.
6. To determine the appropriateness of the code selection and proper
coding, read all instructional material:
– “Includes” and both types of “Excludes” notes
– “Use additional code” and “code first underlying disease” instructions
– “Code also”
– 4th, 5th, and 6th character requirements and 7th character extension
requirements
– Age and sex symbols
7. Consult the official ICD-10-CM guidelines, which govern the use of
specific codes. These guidelines provide both general and chapter-
specific coding guidance.
8. Confirm and assign the correct code.

Organization

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This book is organized in the following manner:

Introduction
The introductory material in this book includes the ICD-10-CM Official
Preface, the history of ICD-10-CM as well as an overview of the
classification system.

Official ICD-10-CM Conventions and Guidelines

This section provides an explanation of the conventions and guidelines
regulating the appropriate assignment and reporting of ICD-10-CM codes.
This coding guidance is presented by the National Center for Health
Statistics (NCHS), a governmental agency of the Centers for Disease Control
and Prevention (CDC), within the United States Department of Health and
Human Services (DHHS).

Alphabetic Index to Diseases

The Alphabetic Index to Diseases is arranged in alphabetic order by disease
— by specific illness, injury, eponym, abbreviation, or other descriptive
diagnostic term. The Index also lists diagnostic terms for other reasons for
encounters with health care professionals.

Neoplasm Table
The Neoplasm Table provides the proper code based upon histology of the
neoplasm and site.

Table of Drugs and Chemicals

The Table of Drugs and Chemicals lists the drug and the specific codes that
identify the drug and the intent. No additional external cause of injury and
poisoning code is assigned in ICD-10-CM.

Index to External Causes

The Alphabetic Index to External Causes of Injuries is arranged in alphabetic
order by main term indicating the event.

Tabular List of Diseases

ICD-10-CM codes and descriptors are arranged numerically within the
tabular list of diseases within 21 separate chapters according to body system or
nature of injury and disease. Classifications that were previously considered
supplemental to ICD-9-CM (e.g., V codes and E codes) are incorporated
into the tabular listing of ICD-10-CM as individual chapters. Chapters 20,

24