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vi TABLE OF CONTENTS
Borderline Diagnosis . . . . . . . . . . . . 57 Infections with a Predominantly Malignant Neoplasm Without

Signs, Symptoms, and Sexual Mode of Transmission Specification of Site . . . . . . . . . . 117
Unspecified Codes . . . . . . . . . . . . 57 (Category Codes A50–A64) . . . . . 85 Additional Coding Guidelines for
Coding for Healthcare Encounters Other Spirochetal Diseases Sequencing of Neoplasm Codes. . 117
in Hurricane Aftermath . . . . . . . . . 58 (Category Codes A65–A69) . . . . . 85 Complications Associated
Chapter-Specific Coding Other Diseases Caused by with Neoplasms. . . . . . . . . . . . . . 118
Guidelines. . . . . . . . . . . . . . . . . . . 59 Chlamydiae (Category Codes Anemia. . . . . . . . . . . . . . . . . . . . . . 118
Section II—Selection of A70–A74) . . . . . . . . . . . . . . . . . . . . 85
Dehydration . . . . . . . . . . . . . . . . . . 118
Principal Diagnosis. . . . . . . . . . . . 60 Rickettsioses (Category Codes
Surgical Procedure Performed for
A75–A79). . . . . . . . . . . . . . . . . . . . 86
Codes for Symptoms, Signs, Treatment of a Malignancy . . . . . 119
and III-Defined Conditions . . . . . . 60 Viral Infections of the Central
Pain. . . . . . . . . . . . . . . . . . . . . . . . . 119
Nervous System (Category Codes
Two or More Interrelated Conditions, Admissions and Encounters
A80–A89) and Arthropod-borne
Each Potentially Meeting the Involving Surgery, Chemotherapy,
Viral Fevers and Viral Hemorrhagic
Definition for Principal Immunotherapy, and Radiation
Fevers (A90–A99) . . . . . . . . . . . . . 86
Diagnosis. . . . . . . . . . . . . . . . . . . . . . 61 Therapy . . . . . . . . . . . . . . . . . . . . 119
B Codes. . . . . . . . . . . . . . . . . . . . . 87
Two or More Diagnoses That Surgery Followed by Chemotherapy
Equally Meet the Definition for Viral Infections Characterized by Skin or Radiation. . . . . . . . . . . . . . . . . 119
Principal Diagnosis. . . . . . . . . . . . 61 and Mucous Membrane Lesions
Encounter or Admission Solely for
Two or More Comparative or (Category Codes B00–B09) . . . . . 87
Administration of Chemotherapy,
Contrasting Conditions. . . . . . . . . 62 Other Human Herpesviruses Immunotherapy, or Radiation. . . 120
Original Treatment Plan Not (Category Code B10). . . . . . . . . . . 87
Radiation Therapy, Chemotherapy,
Carried Out . . . . . . . . . . . . . . . . . . 62 Viral Hepatitis (Category Codes or Immunotherapy Followed by
Complications of Surgery and B15–B19). . . . . . . . . . . . . . . . . . . . 88 Complications. . . . . . . . . . . . . . . 120
Other Medical Care. . . . . . . . . . . . 62 Human Immunodeficiency Virus (HIV) Admission or Encounter to
Uncertain Diagnosis. . . . . . . . . . . . . 63 Disease (Category Code B20). . . . 88 Determine Extent of Malignancy
Admission from Observation Other Viral Diseases (Category or to Perform a Procedure . . . . . 121
Unit, Following Post-Operative Codes B25–B34). . . . . . . . . . . . . . 90 Symptoms, Signs and Abnormal
Observation, or Outpatient Mycoses (Category Codes Findings Listed in Chapter 18 (of ICD-
Surgery . . . . . . . . . . . . . . . . . . . . . 63 B35–B49). . . . . . . . . . . . . . . . . . . . 90 10-CM) Associated with Neoplasms,
Admissions/Encounters for Additional B Codes . . . . . . . . . . . . . 91 and Admission/Encounter for Pain
Rehabilitation. . . . . . . . . . . . . . . . . 64 Summary. . . . . . . . . . . . . . . . . . . . 94 Control/Management.. . . . . . . . . . 121
Section III—Reporting Additional Internet Links . . . . . . . . . . . . . . . . 94 Summary. . . . . . . . . . . . . . . . . . . 122
Diagnoses. . . . . . . . . . . . . . . . . . . 65 Internet Links . . . . . . . . . . . . . . . 122
Chapter Review. . . . . . . . . . . . . . . 94
Section IV—Diagnostic Coding Chapter Review. . . . . . . . . . . . . . 122
Coding Assignments. . . . . . . . . . . 95
and Reporting Guidelines for
Case Studies. . . . . . . . . . . . . . . . . 96 Coding Assignments. . . . . . . . . . 123
Outpatient Services . . . . . . . . . . . 66
Case Studies. . . . . . . . . . . . . . . . 124
Summary. . . . . . . . . . . . . . . . . . . . 70
Internet Link . . . . . . . . . . . . . . . . . 70 Chapter 7: Neoplasms
Chapter Review. . . . . . . . . . . . . . . 70 100 Chapter 8: Diseases of
the Blood and Blood-
Chapter 6: Infectious and
Introduction��101 Forming Organs 128
Abbreviations��101
Parasitic Diseases 73 Introduction to the Body Introduction ��129
System. . . . . . . . . . . . . . . . . . . . . 102 Abbreviations ��129
Introduction . . . . . . . . . . . . . . . . . 74
Malignant Versus Benign Introduction to the Body System��129
Abbreviations . . . . . . . . . . . . . . . . 75
Neoplasms. . . . . . . . . . . . . . . . . .102 Blood Composition . . . . . . . . . . . . 129
Organisms Found in Chapter. . . . . . 75 Coding of Neoplasms . . . . . . . . . 105 Coding of Diseases of the Blood
Bacteria . . . . . . . . . . . . . . . . . . . . . . 75
General Neoplasm Guidelines. . . . 106 and Blood-Forming Organs. . . . . 133
Fungi. . . . . . . . . . . . . . . . . . . . . . . . . 77
Locating a Neoplasm Code. . . . . . 106 Anemia. . . . . . . . . . . . . . . . . . . . . . 133
Parasites. . . . . . . . . . . . . . . . . . . . . . 77
Sequencing of Codes . . . . . . . . . . 110 Nutritional Anemias (D50–D53). . . 133
Viruses. . . . . . . . . . . . . . . . . . . . . . . 78
Malignancy as Principal Diagnosis. . 111 Hemolytic Anemias (Category
Coding of Infectious and
Eradication of Malignancy Codes D55–D59). . . . . . . . . . . . . 134
Parasitic Diseases . . . . . . . . . . . . 79
and Follow-Up Examinations . . . 111 Aplastic and Other Anemias and Other
Single-Code Assignment. . . . . . . . . 79 Treatment Followed by Bone Marrow Failure Syndromes
Combination-Code Assignment . . . 79 Recurrence . . . . . . . . . . . . . . . . . 111 (Category Codes D60–D64). . . . . . 136
Dual-Code Assignment. . . . . . . . . . 80 Excised Malignancy Followed by Coagulation Defects, Purpura, and
A Codes. . . . . . . . . . . . . . . . . . . . . 80 Recurrence . . . . . . . . . . . . . . . . . 111 Other Hemorrhagic Conditions
Intestinal Infectious Diseases Follow-Up Visit with No (Category Codes D65–D69) . . . . 137
(Category Codes A00–A09) . . . . . 80 Recurrence . . . . . . . . . . . . . . . . . 111 Other Disorders of the Blood and
Tuberculosis (Category Codes Two Primary Sites . . . . . . . . . . . . . 112 Blood-Forming Organs (Category
A15–A19) . . . . . . . . . . . . . . . . . . . . 81 Primary and Secondary Codes D70–D77). . . . . . . . . . . . . 140
Certain Zoonotic Bacterial Diseases Malignancies. . . . . . . . . . . . . . . . 112 Summary. . . . . . . . . . . . . . . . . . . 146
(Category Codes A20–A28) . . . . . 82 Malignancy in Two or More Internet Links . . . . . . . . . . . . . . . 146
Other Bacterial Diseases (Category Noncontiguous Sites. . . . . . . . . . 116 Chapter Review. . . . . . . . . . . . . . 146
Codes A30–A49). . . . . . . . . . . . . . 82 Unspecified Disseminated
Coding Assignments. . . . . . . . . . 147
Malignant Neoplasm. . . . . . . . . . 116
Case Studies. . . . . . . . . . . . . . . . 148
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TABLE OF CONTENTS vii
Chapter 9: Endocrine, Disorders of Adult Personality and

Behavior (Category Codes
Chapter 12: Disorders of
Nutritional, and F60–F69) . . . . . . . . . . . . . . . . . . . 179 the Eye and Adnexa 205
Metabolic Diseases 151 Intellectual Disabilities (Category
Codes F70–F79) . . . . . . . . . . . . . 179 Introduction . . . . . . . . . . . . . . . . 206
Introduction ��152 Pervasive and Specific Abbreviations . . . . . . . . . . . . . . . 206
Introduction to the Body System. . 152 Developmental Disorders Introduction to the Body
Coding of Endocrine, Nutritional, (Category Codes F80–F89). . . . . 180 System. . . . . . . . . . . . . . . . . . . . . 206
and Metabolic Diseases. . . . . . . 154 Behavioral and Emotional Disorders Coding Disorders of the Eye
with Onset Usually Occurring and Adnexa. . . . . . . . . . . . . . . . . 208
Disorders of the Thyroid Gland in Childhood and Adolescence
(Category Codes E00–E07). . . . . 154 (Category Codes F90–F98). . . . . 181 Disorders of Eyelid, Lacrimal
Diabetes Mellitus E08–E13 . . . . . . 157 System, and Orbit (Category
Unspecified Mental Disorder Codes H00–H05). . . . . . . . . . . . . 208
Types of Diabetes Mellitus. . . . . . . 158 (Category Code F99). . . . . . . . . . 182
Other Disorders of Glucose Disorders of Conjunctiva (Category
Summary. . . . . . . . . . . . . . . . . . . 182 Codes H10–H11) . . . . . . . . . . . . . 209
Regulation and Pancreatic
Internal Secretion (Category Internet Links . . . . . . . . . . . . . . . 183 Disorders of Sclera, Cornea, Iris,
Codes E15–E16) . . . . . . . . . . . . . 160 Chapter Review. . . . . . . . . . . . . . 183 and Ciliary Body (Category
Disorders of Other Endocrine Glands Coding Assignments. . . . . . . . . . 185 Code H15–H22). . . . . . . . . . . . . . 209
(Category Codes E20–E35). . . . . 161 Disorders of Lens (Category
Case Studies. . . . . . . . . . . . . . . . 186 Codes H25–H28). . . . . . . . . . . . . 210
Malnutrition (Category Codes
E40–E46). . . . . . . . . . . . . . . . . . . 162 Disorders of Choroid and Retina
Other Nutritional Deficiencies Chapter 11: Diseases of (Category Codes H30–H36). . . . 211
(Category Codes E50–E64) and the Nervous System 191 Glaucoma (Category Codes
Overweight, Obesity, and Other H40–H42). . . . . . . . . . . . . . . . . . . 211
Hyperalimentation (Category Introduction . . . . . . . . . . . . . . . . 192 Disorders of Vitreous Body and Globe
Codes E65–E68) . . . . . . . . . . . . . 162 Introduction to the Body (Category Codes H43–H44) . . . . 212
Metabolic Disorders and System. . . . . . . . . . . . . . . . . . . . . 192 Disorders of Optic Nerve and
Postprocedural Complications Visual Pathways (Category
(Category Codes E70–E89). . . . . 162 Coding of Diseases of the Codes H46–H47). . . . . . . . . . . . . 212
Nervous System . . . . . . . . . . . . . 192
Summary. . . . . . . . . . . . . . . . . . . 163 Disorders of Ocular Muscles,
Inflammatory Diseases of the Binocular Movement,
Internet Links . . . . . . . . . . . . . . . 163 Central Nervous System (Category Accommodation, and Refraction
Chapter Review. . . . . . . . . . . . . . 163 Codes G00–G09) . . . . . . . . . . . . 192 (Category Codes H49–H52) . . . . 213
Coding Assignments. . . . . . . . . . 165 Systemic Atrophies Primarily Visual Disturbances and Blindness
Case Studies. . . . . . . . . . . . . . . . 166 Affecting the Central Nervous (Category Codes H53–H54). . . . 213
System (Category Codes Other Disorders of Eye and
G10–G14). . . . . . . . . . . . . . . . . . . 193 Adnexa (Category Codes
Chapter 10: Mental, Extrapyramidal and Movement H55–H59). . . . . . . . . . . . . . . . . . . 213
Behavioral, and Disorders (Category Codes Summary. . . . . . . . . . . . . . . . . . . 213
G20–G26) . . . . . . . . . . . . . . . . . . 194
Neurodevelopmental Other Degenerative Diseases of Internet Links . . . . . . . . . . . . . . . 214
Disorders 170 the Nervous System (Category Chapter Review. . . . . . . . . . . . . . 214
Codes G30–G32). . . . . . . . . . . . . 194 Coding Assignments. . . . . . . . . . 215
Introduction ��171 Demyelinating Diseases of the Case Studies. . . . . . . . . . . . . . . . 216
Introduction to the Body Central Nervous System (Category
System ��171 Codes G35–G37). . . . . . . . . . . . .195
Coding of Mental, Behavioral, Episodic and Paroxysmal Disorders Chapter 13: Diseases
and Neurodevelopmental (Category Codes G40–G47). . . . 195 of the Ear and
Disorders. . . . . . . . . . . . . . . . . . . 172 Nerve, Nerve Root, and Plexus
Disorders (Category Codes
Mastoid Process 219
Mental Disorders Due to Known
Physiological Conditions (Category G50–G59) . . . . . . . . . . . . . . . . . . 196 Introduction . . . . . . . . . . . . . . . . 220
Codes F01–F09) . . . . . . . . . . . . . 172 Polyneuropathies and Other Disorders
of the Peripheral Nervous System Introduction to the Body
Mental and Behavioral Disorders Due System. . . . . . . . . . . . . . . . . . . . . 220
to Psychoactive Substance Use (Category Codes G60–G65). . . . . 196
(Category Codes F10–F19). . . . . 173 Diseases of Myoneural Junction Coding Diseases of the Ear and
and Muscle (Category Code Mastoid Process. . . . . . . . . . . . . 222
Schizophrenia, Schizotypal,
Delusional, and Other Non-Mood G70–G73). . . . . . . . . . . . . . . . . . . 196 Diseases of the External Ear
Psychotic Disorders (Category Cerebral Palsy and Other Paralytic (Category Codes H60–H62). . . . 222
Codes F20–F29) . . . . . . . . . . . . . 176 Syndromes (Category Codes Diseases of the Middle Ear and
Mood [Affective] Disorders G80–G83) . . . . . . . . . . . . . . . . . . 196 Mastoid (Category Codes
(Category Codes F30–F39) . . . . . 176 Other Disorders of the Nervous H65–H75). . . . . . . . . . . . . . . . . . . 223
Anxiety, Dissociative, Stress- System (Category Codes Diseases of Inner Ear (Category
Related, Somatoform, and Other G89–G99) . . . . . . . . . . . . . . . . . . 197 Codes H80–H83). . . . . . . . . . . . . 224
Nonpsychotic Mental Disorders Summary. . . . . . . . . . . . . . . . . . . 199 Other Disorders of Ear (Category
(Category Codes F40–F48). . . . . 177 Internet Links . . . . . . . . . . . . . . . 199 Codes H90–H94) and
Behavioral Syndromes Associated Intraoperative and Postprocedural
Chapter Review. . . . . . . . . . . . . . 199 Complications and Disorders of
with Physiological Disturbances
and Physical Factors (Category Coding Assignments. . . . . . . . . . 200 Ear and Mastoid Process, Not
Codes F50–F59) . . . . . . . . . . . . . 178 Case Studies. . . . . . . . . . . . . . . . 201 Elsewhere Classified (H95). . . . . 224
viii TABLE OF CONTENTS
Summary. . . . . . . . . . . . . . . . . . . 225 Chronic Lower Respiratory Diseases

(Category Codes J40–J47). . . . . 261
Chapter 17: Diseases
Internet Links . . . . . . . . . . . . . . . 225
Lung Diseases Due to External of the Skin and
Chapter Review. . . . . . . . . . . . . . 225
Agents (Category Codes Subcutaneous Tissue 287
Coding Assignments. . . . . . . . . . 226 J60–J70) . . . . . . . . . . . . . . . . . . . 262
Case Studies. . . . . . . . . . . . . . . . 227 Other Respiratory Diseases Introduction . . . . . . . . . . . . . . . . 288
Principally Affecting the Interstitium Introduction to the Body
(Category Codes J80–J84). . . . . 262 System. . . . . . . . . . . . . . . . . . . . . 288
Chapter 14: Diseases Suppurative and Necrotic Conditions Coding of Diseases of the Skin
of the Circulatory of the Lower Respiratory Tract and Subcutaneous Tissue . . . . . 289
System 230 (Category Codes J85–J86). . . . . 262
Infections of Skin and
Other Diseases of the Pleura (Category Subcutaneous Tissue (Category
Introduction . . . . . . . . . . . . . . . . 231 Codes J90–J94) and Intraoperative Codes L00–L08) . . . . . . . . . . . . . 289
Introduction to the Body and Postprocedural Complications
and Disorders of Respiratory Bullous Disorders (Category
System. . . . . . . . . . . . . . . . . . . . . 231 Codes L10–L14). . . . . . . . . . . . . . 292
System, Not Elsewhere Classified
Coding of Diseases of the (Category Code J95). . . . . . . . . . . 263 Dermatitis and Eczema (Category
Circulatory System. . . . . . . . . . . 234 Codes L20–L30) . . . . . . . . . . . . . 292
Other Diseases of the Respiratory
Acute and Chronic Rheumatic Fever System (Category Codes Papulosquamous Disorders
(Category Codes I00–I09). . . . . . 234 J96–J99) . . . . . . . . . . . . . . . . . . . 263 (Category Codes L40–L45) and
Hypertensive Diseases (Category Summary. . . . . . . . . . . . . . . . . . . 264 Urticaria and Erythema (Category
Codes I10–I16). . . . . . . . . . . . . . . 236 Codes L49–L54) . . . . . . . . . . . . . 293
Internet Links . . . . . . . . . . . . . . . 264 Radiation-Related Disorders of the
Ischemic Heart Diseases (Category
Codes I20–I25) . . . . . . . . . . . . . . 238 Chapter Review. . . . . . . . . . . . . . 265 Skin and Subcutaneous Tissue
Pulmonary Heart Disease and Coding Assignments. . . . . . . . . . 266 (Category Codes L55–L59). . . . . 293
Diseases of Pulmonary Circulation Case Studies. . . . . . . . . . . . . . . . 267 Disorders of Skin Appendages
(Category Codes I26–I28). . . . . . 243 (Category Codes L60–L75). . . . . 294
Other Forms of Heart Disease Intraoperative and Postprocedural
(Category Codes I30–I52). . . . . . 243 Chapter 16: Diseases of Complications of Skin and
Cerebrovascular Diseases the Digestive System 270 Subcutaneous Tissue (Category
(Category Codes I60–I69). . . . . . 245 Code L76) . . . . . . . . . . . . . . . . . . 294
Disease of Arteries, Arterioles, Introduction . . . . . . . . . . . . . . . . 271 Other Diseases of the Skin and
and Capillaries (Category Introduction to the Body Subcutaneous Tissue (Category
Codes I70–I79) . . . . . . . . . . . . . . 246 System. . . . . . . . . . . . . . . . . . . . . 271 Codes L80–L99) . . . . . . . . . . . . . 294
Diseases of Veins, Lymphatic Summary. . . . . . . . . . . . . . . . . . . 297
Coding Diseases of the
Vessels, and Lymph Nodes, Not Digestive System . . . . . . . . . . . . 272 Internet Links . . . . . . . . . . . . . . . 297
Elsewhere Classified (Category Chapter Review. . . . . . . . . . . . . . 297
Diseases of the Oral Cavity and
Codes I80–I89). . . . . . . . . . . . . . . 247
Salivary Glands (Category Coding Assignments. . . . . . . . . . 298
Other and Unspecified Disorders of Codes K00–K14) . . . . . . . . . . . . . 272
the Circulatory System (Category Case Studies. . . . . . . . . . . . . . . . 299
Disease of Esophagus, Stomach,
Codes I95–I99) . . . . . . . . . . . . . . 247
and Duodenum (Category
Summary. . . . . . . . . . . . . . . . . . . 248 Codes K20–K31). . . . . . . . . . . . . 273 Chapter 18: Diseases
Internet Links . . . . . . . . . . . . . . . 248 Diseases of Appendix (Category of the Musculoskeletal
Chapter Review. . . . . . . . . . . . . . 248 Codes K35–K38). . . . . . . . . . . . . 275 System and Connective
Hernia (Category Codes
K40–K46). . . . . . . . . . . . . . . . . . . 276 Tissue 304
Case Studies. . . . . . . . . . . . . . . . 250
Noninfective Enteritis and Colitis Introduction �� 305
(Category Code K50–K52) . . . . . 277
Chapter 15: Diseases Other Diseases of the Intestines Introduction to the Body
System. . . . . . . . . . . . . . . . . . . . . 305
of the Respiratory (Category Codes K55–K64) . . . . 277
Coding of Diseases of the
System 255 Diseases of Peritoneum and
Retroperitoneum (Category Musculoskeletal System and
Codes K65–K68). . . . . . . . . . . . . 278 Connective Tissue . . . . . . . . . . . 307
Introduction . . . . . . . . . . . . . . . . 256
Disease of Liver (Category Infectious Arthropathies (Category
Introduction to the Body Codes K70–K77). . . . . . . . . . . . . 278 Codes M00–M02) . . . . . . . . . . . . 308
System. . . . . . . . . . . . . . . . . . . . . 256 Autoinflammatory Syndromes
Disorders of Gall Bladder, Biliary
Coding Diseases of the Tract, and Pancreas (Category (M04) and Inflammatory
Respiratory System. . . . . . . . . . . 257 Codes K80–K87). . . . . . . . . . . . . 278 Polyarthropathies (Category
Acute Upper Respiratory Infections Other Diseases of the Digestive Codes M05–M14) . . . . . . . . . . . . 308
(Category Codes J00–J06). . . . . 258 System (Category Codes Osteoarthritis (Category Codes
Influenza and Pneumonia (Category K90–K95). . . . . . . . . . . . . . . . . . . 280 M15–M19) . . . . . . . . . . . . . . . . . . 309
Codes J09–J18). . . . . . . . . . . . . . 259 Summary. . . . . . . . . . . . . . . . . . . 280 Other Joint Disorders (Category
Other Acute Lower Respiratory Internet Links . . . . . . . . . . . . . . . 280 Codes M20–M25) . . . . . . . . . . . . 309
Infections (Category Codes Dentofacial Anomalies [Including
Chapter Review. . . . . . . . . . . . . . 280 Malocclusion] and Other
J20–J22) . . . . . . . . . . . . . . . . . . . 260
Other Diseases of Upper Coding Assignments. . . . . . . . . . 281 Disorders of Jaw (Category
Respiratory Tract (Category Case Studies. . . . . . . . . . . . . . . . 282 Codes M26–M27) . . . . . . . . . . . . 310
Codes J30–J39). . . . . . . . . . . . . . . 260
TABLE OF CONTENTS ix
Systemic Connective Tissue Summary. . . . . . . . . . . . . . . . . . . 333 Abnormal Findings on Neonatal

Disorders (Category Codes Internet Links . . . . . . . . . . . . . . . 333 Screening (Category Code P09). . 365
M30–M36). . . . . . . . . . . . . . . . . . 310 Birth Trauma (Category Codes
Chapter Review. . . . . . . . . . . . . . 333
Dorsopathies (Category Codes P10–P15). . . . . . . . . . . . . . . . . . . 365
M40–M54). . . . . . . . . . . . . . . . . . 311 Coding Assignments. . . . . . . . . . 334 Respiratory and Cardiovascular
Soft Tissue Disorders (Category Case Studies. . . . . . . . . . . . . . . . 335 Disorders Specific to the
Codes M60–M79) . . . . . . . . . . . . 311 Perinatal Period (Category
Codes P19–P29) . . . . . . . . . . . . . 366
Osteopathies and Chondropathies
(Category Codes M80–M94). . . . 312
Chapter 20: Pregnancy, Infections Specific to the
Other Disorders of the Childbirth, and the Perinatal Period (Category
Musculoskeletal System and Puerperium 340 Codes P35–P39). . . . . . . . . . . . . 366
Connective Tissue (Category Hemorrhagic and Hematologic
Code M95). . . . . . . . . . . . . . . . . . 315 Introduction . . . . . . . . . . . . . . . . 341 Disorders of Newborn (Category
Intraoperative and Postprocedural Introduction to the Body Codes P50–P61) . . . . . . . . . . . . . 367
Complications and Disorders System. . . . . . . . . . . . . . . . . . . . . 341 Transitory Endocrine and Metabolic
of Musculoskeletal System, Not Disorders Specific to Newborn
Coding for Pregnancy, Childbirth,
Elsewhere Classified (Category (Category Codes P70–P74). . . . . 368
and the Puerperium . . . . . . . . . . 342
Code M96) Periprosthetic Fracture Digestive System Disorders of
Around Internal Prosthetic Pregnancy with Abortive Outcome Newborn (Category Codes
Joint (Category Code M97) and (Category Codes O00–O08) P76–P78). . . . . . . . . . . . . . . . . . . 368
Biomechanical Lesions, Not and Supervision of High-Risk
Conditions Involving the Integument
Elsewhere Classified (Category Pregnancy (Category
and Temperature Regulation of
Code M99). . . . . . . . . . . . . . . . . . 315 Code O09). . . . . . . . . . . . . . . . . . . . 344
Newborn (Category Codes P80–P83)
Summary. . . . . . . . . . . . . . . . . . . 315 Routine Outpatient Prenatal and Other Problems with Newborns
Visits . . . . . . . . . . . . . . . . . . . . . . 347 (Category Code P84). . . . . . . . . . . . 368
Internet Links . . . . . . . . . . . . . . . 316
Edema, Proteinuria, and Hypertensive Other Disorders Originating in the
Chapter Review. . . . . . . . . . . . . . 316 Disorders in Pregnancy, Childbirth, Perinatal Period (Category Codes
Coding Assignments. . . . . . . . . . 317 and the Puerperium (Category P90–P96). . . . . . . . . . . . . . . . . . . 368
Case Studies. . . . . . . . . . . . . . . . 318 Codes O10–O16). . . . . . . . . . . . . 347
Summary. . . . . . . . . . . . . . . . . . . 369
Other Maternal Disorders
Predominantly Related to Internet Links . . . . . . . . . . . . . . . 369
Chapter 19: Diseases Pregnancy (Category Codes Chapter Review. . . . . . . . . . . . . . 369
of the Genitourinary O20–O29) . . . . . . . . . . . . . . . . . . 348 Coding Assignments. . . . . . . . . . 370
System 322 Maternal Care Related to the Fetus
and Amniotic Cavity and Possible
Case Studies. . . . . . . . . . . . . . . . 371
Introduction �� 323 Delivery Problems (Category

Introduction to the Body
Codes O30–O48) . . . . . . . . . . . . 349 Chapter 22: Congenital
System. . . . . . . . . . . . . . . . . . . . . 323
Complications of Labor and Delivery
(Category Codes O60–O77). . . . 351
Malformations,
Coding Diseases of the Encounter for Delivery (Category
Deformations, and
Genitourinary System. . . . . . . . . 325 Codes O80 and O82). . . . . . . . . . 352 Chromosomal
Glomerular Diseases (Category Complications Predominately Abnormalities 375
Codes N00–N08). . . . . . . . . . . . . 325 Related to the Puerperium
Renal Tubulo-Interstitial Diseases (Category Codes O85–O92). . . . 354 Introduction ��376
(Category Codes N10–N16) . . . . 326 Other Obstetric Conditions, Not Introduction to the Body System . . 376
Acute Kidney Failure and Chronic Elsewhere Classified (Category
Coding Congenital Malformations,
Kidney Disease (Category Codes O94–O9A) . . . . . . . . . . . . 354
Deformations, and Chromosomal
Codes N17–N19) . . . . . . . . . . . . . 327 Additional Coding Guidelines . . . . 356 Abnormalities . . . . . . . . . . . . . . . 376
Urolithiasis (Category Codes Summary. . . . . . . . . . . . . . . . . . . 356
N20–N23). . . . . . . . . . . . . . . . . . . 328 Congenital Malformations of the
Internet Links . . . . . . . . . . . . . . . 356 Nervous System (Category
Other Disorders of Kidney and
Chapter Review. . . . . . . . . . . . . . 356 Codes Q00–Q07) . . . . . . . . . . . . 377
Ureter (Category Codes
N25–N29). . . . . . . . . . . . . . . . . . . 329 Coding Assignments. . . . . . . . . . 357 Congenital Malformations of Eye,
Ear, Face, and Neck (Category
Other Diseases of the Urinary Case Studies. . . . . . . . . . . . . . . . 358 Codes Q10–Q18). . . . . . . . . . . . . 378
System (Category Codes
N30–N39). . . . . . . . . . . . . . . . . . .329 Congenital Malformations of the
Diseases of Male Genital Organs Chapter 21: Certain Circulatory System (Category
(Category Codes N40–N53) . . . . 331 Conditions Originating in Codes Q20–Q28). . . . . . . . . . . . . 379
Congenital Malformations of the
Disorders of Breast (Category the Perinatal Period 362 Respiratory System (Category
Codes N60–N65). . . . . . . . . . . . . 331
Codes Q30–Q34). . . . . . . . . . . . .379
Inflammatory Diseases of Female Introduction . . . . . . . . . . . . . . . . 362
Cleft Lip and Cleft Palate (Category
Pelvic Organs (Category Codes Coding Guidelines for Certain Codes Q35–Q37). . . . . . . . . . . . .379
N70–N77). . . . . . . . . . . . . . . . . . . 332 Conditions Originating in the Other Congenital Malformations of
Noninflammatory Disorders of the Perinatal Period . . . . . . . . . . . . . 363 the Digestive System (Category
Female Genital Tract (Category
Newborn Affected by Maternal Codes Q38–Q45) . . . . . . . . . . . . 380
Codes N80–N98). . . . . . . . . . . . . 332
Factors and by Complications Congenital Malformations of
Intraoperative and Postprocedural of Pregnancy, Labor, and Delivery Genital Organs (Category Codes
Complications and Disorders (Category Codes P00–P04) . . . . 364 Q50–Q56) . . . . . . . . . . . . . . . . . . 380
of Genitourinary System, Not
Disorders of Newborn Related to Congenital Malformations of the
Elsewhere Classified (Category
Length of Gestation and Fetal Growth Urinary System (Category
Code N99). . . . . . . . . . . . . . . . . . 333
(Category Codes P05–P08). . . . . . 365 Codes Q60–Q64) . . . . . . . . . . . . 381
x TABLE OF CONTENTS
Congenital Malformations and of Urine Without Diagnosis Other and Unspecified Effects of
Deformations of the (Category Codes R80–R82) . . . . 399 External Causes (Category
Musculoskeletal System Abnormal Findings on Examination Codes T66–T78) . . . . . . . . . . . . . 422
(Category Codes Q65–Q79). . . . 382 of Other Body Fluids, Substances, Complications of Surgical and
Other Congenital Malformations and Tissues, Without Diagnosis Medical Care, Not Elsewhere
(Category Codes Q80–Q89) (Category Codes R83–R89) . . . . 399 Classified (Category Codes
and Chromosomal Abnormalities, Abnormal Findings on Diagnostic T80–T88) . . . . . . . . . . . . . . . . . . . 423
Not Elsewhere Classified Imaging and in Function Studies, Summary. . . . . . . . . . . . . . . . . . . 425
(Category Codes Q90–Q99). . . . 383 Without Diagnosis (Category Internet Links . . . . . . . . . . . . . . . 425
Summary. . . . . . . . . . . . . . . . . . . 383 Codes R90–R94), Abnormal
Tumor Markers (Category Code Chapter Review. . . . . . . . . . . . . . 425
Internet Links . . . . . . . . . . . . . . . 383
R97), and Ill-defined and Unknown Coding Assignments. . . . . . . . . . 426
Chapter Review. . . . . . . . . . . . . . 384 Cause of Mortality (Category Case Studies. . . . . . . . . . . . . . . . 428
Coding Assignments. . . . . . . . . . 384 Code R99) . . . . . . . . . . . . . . . . . . 400
Case Studies. . . . . . . . . . . . . . . . 385 Summary. . . . . . . . . . . . . . . . . . . 401
Chapter Review. . . . . . . . . . . . . . 401
Chapter 25: External
Chapter 23: Symptoms, Coding Assignments. . . . . . . . . . 402
Causes of Morbidity 432
Signs, and Abnormal Case Studies. . . . . . . . . . . . . . . . 403 Introduction �� 433
Clinical Laboratory Coding External Causes of
Findings 389 Chapter 24: Injury, Morbidity. . . . . . . . . . . . . . . . . . . 434
Poisoning, and Certain Transport Accidents (Category
Introduction �� 390
Other Consequences of Codes V00–V99) . . . . . . . . . . . . . 436
Pedestrian Injured in Transport
Coding of Symptoms, Signs, and
Abnormal Clinical and Laboratory External Causes 407 Accident (Category Codes
Findings, Not Elsewhere V00–V09). . . . . . . . . . . . . . . . . . . 437
Classified . . . . . . . . . . . . . . . . . . 390 Introduction . . . . . . . . . . . . . . . . 408
Pedal Cycle Rider Injured in
Coding Guidelines for Symptoms, Coding Guidelines. . . . . . . . . . . . 409 Transport Accident (Category
Signs, and Abnormal Clinical and Terminology. . . . . . . . . . . . . . . . . 410 Codes V10–V19) . . . . . . . . . . . . . 437
Laboratory Findings, Not Fractures . . . . . . . . . . . . . . . . . . . . 410 Motorcycle Rider Injured in Transport
Elsewhere Classified . . . . . . . . . 392 Accident (Category Codes
Gustilo Classification of Fractures. . 412
Guideline for Principal V20–V29). . . . . . . . . . . . . . . . . . . 437
S Codes. . . . . . . . . . . . . . . . . . . . 413
Diagnosis. . . . . . . . . . . . . . . . . . . 392 Occupant of Three-Wheeled Motor
Injuries to the Head (Category Vehicle Injured in Transport
Symptoms and Signs as Codes S00–S09). . . . . . . . . . . . . 414
Secondary Codes. . . . . . . . . . . . 393 Accident (Category Codes
Injuries to the Neck (Category V30–V39). . . . . . . . . . . . . . . . . . . 437
Difference Between Inpatient and Codes S10–S19) . . . . . . . . . . . . . 414
Outpatient Coding Guidelines. . .393 Car Occupant Injured in Transport
Injuries to the Thorax (Category Accident (Category Codes
Chapter 18 Specific Coding Codes S20–29) . . . . . . . . . . . . . . 415 V40–V49) . . . . . . . . . . . . . . . . . . . 438
Guidelines. . . . . . . . . . . . . . . . . . 394
Injuries to the Abdomen, Lower Occupant of Pickup Truck or Van
Symptoms and Signs Involving Back, Lumbar Spine, Pelvis, and Injured in Transport Accident
the Circulatory and Respiratory External Genitals (Category (Category Codes V50–V59). . . . . 438
Systems (Category Codes Codes S30–S39). . . . . . . . . . . . . 415
R00–R09). . . . . . . . . . . . . . . . . . . 394 Occupant of Heavy Transport Vehicle
Injuries to the Shoulder and Arm, Injured in Transport Accident
Symptoms and Signs Involving Elbow, Wrist, and Hand (Category (Category Codes V60–V69). . . . . 439
the Digestive System and Codes S40–S69). . . . . . . . . . . . . 415
Abdomen (Category Codes Bus Occupant Injured in Transport
R10–R19). . . . . . . . . . . . . . . . . . . 395 Injuries to the Hip, Thigh, Knee, Accident (Category Codes
Lower Leg, Ankle, Foot, and Toes V70–V79). . . . . . . . . . . . . . . . . . . 439
Symptoms and Signs Involving the (Category Codes S70–S99) . . . . 416
Skin and Subcutaneous Tissue Other Land Transport Accidents
(Category Codes R20–R23) . . . . 395 T Codes. . . . . . . . . . . . . . . . . . . . 417 (Category Codes V80–V89). . . . . 439
Symptoms and Signs Involving the Injuries Involving Unspecified Water Transport Accidents (Category
Nervous and Musculoskeletal Multiple Body Regions (Category Codes V90–V94) . . . . . . . . . . . . . 439
Systems (Category Codes Code T07) . . . . . . . . . . . . . . . . . . 417 Air and Space Transport Accidents
R25–R29). . . . . . . . . . . . . . . . . . . 395 Injury of Unspecified Body Region (Category Codes V95–V97). . . . . 440
Symptoms and Signs Involving the (Category Code T14). . . . . . . . . . 417 Other and Unspecified Transport
Genitourinary System (Category Effects of Foreign Body Entering Accidents (Category Codes
Codes R30–R39). . . . . . . . . . . . . 396 Through Natural Orifice (Category V98–V99). . . . . . . . . . . . . . . . . . . 440
Symptoms and Signs Involving Codes T15–T19). . . . . . . . . . . . . . 417 Other External Causes of
Cognition, Perception, Emotional Burns and Corrosions (Category Accidental Injury (Category Codes
State, and Behavior (Category Codes T20–T32) . . . . . . . . . . . . . 417 W00–X58) . . . . . . . . . . . . . . . . . . 440
Codes R40–R46). . . . . . . . . . . . . 396 Frostbite (Category Codes Slipping, Tripping, Stumbling, and Falls
Symptoms and Signs Involving T33–T34) . . . . . . . . . . . . . . . . . . . 420 (Category Codes W00–W19). . . . . 440
Speech and Voice (Category Poisoning by Adverse Effects of and Exposure to Inanimate
Codes R47–R49) . . . . . . . . . . . . . 397 Underdosing of Drugs, Medicaments, Mechanical Forces (Category
General Symptoms and Signs and Biological Substances (Category Codes W20–W49) . . . . . . . . . . . . 441
(Category Codes R50–R69) . . . . 398 Codes T36–T50). . . . . . . . . . . . . . . 420 Exposure to Animate Mechanical
Abnormal Findings on Examination Toxic Effects of Substances Chiefly Forces (Category Codes
of Blood Without Diagnosis Nonmedicinal as to Source W50–W64). . . . . . . . . . . . . . . . . . 442
(Category Codes R70–R79) and (Category Codes T51–T65). . . . . 422 Accidental Non-Transport Drowning
Abnormal Findings on Examination and Submersion (Category Codes
W65–W74). . . . . . . . . . . . . . . . . . 442
TABLE OF CONTENTS xi
Exposure to Electric Current, and Psychosocial Circumstances Principles for the Medical and
Radiation, and Extreme Ambient (Category Codes Z55–Z65). . . . . 469 Surgical Section . . . . . . . . . . . . . 512
Air Temperature and Pressure Do Not Resuscitate Status Appendices in ICD-10-PCS. . . . . . 513
(Category Codes W85–W99) . . . 442 (Category Code Z66). . . . . . . . . . 469 Summary. . . . . . . . . . . . . . . . . . . 515
Exposure to Smoke, Fire, and Flames Blood Type (Category
(Category Codes X00–X08). . . . . 442 Internet Links . . . . . . . . . . . . . . . 515
Code Z67) . . . . . . . . . . . . . . . . . . 469
Contact with Heat and Hot Body Mass Index (BMI) (Category Chapter Review. . . . . . . . . . . . . . 515
Substances (Category Codes Code Z68) . . . . . . . . . . . . . . . . . . 469 Coding Assignments. . . . . . . . . . 516
X10–X19) . . . . . . . . . . . . . . . . . . . 443 Persons Encountering Health Case Studies. . . . . . . . . . . . . . . . 517
Exposure to Forces of Nature Services in Other Circumstances
(Category Codes X30–X39). . . . . 443 (Category Codes Z69–Z76). . . . . 469
Overexertion and Strenuous or Persons with Potential Health Chapter 29: Obstetrics
Repetitive Movement (Category Hazards Related to Family and Section 521
Code X50) and Accidental Exposure Personal History and Certain
to Other Specified Factors Conditions Influencing Health Introduction . . . . . . . . . . . . . . . . 522
(Category Codes X52, X58). . . . . 443 Status (Category Codes ICD-10-PCS Official Coding
Intentional Self-Harm (Category Z77–Z99) . . . . . . . . . . . . . . . . . . . 470 Guidelines for Obstetric
Codes X71–X83) . . . . . . . . . . . . . 443 Additional Guidelines. . . . . . . . . 473 Section . . . . . . . . . . . . . . . . . . . . 522
Assault (Category Codes Summary. . . . . . . . . . . . . . . . . . . 475 Obstetrics Section of the
X92–Y09). . . . . . . . . . . . . . . . . . . 443
Internet Links . . . . . . . . . . . . . . . 475 ICD-10-PCS. . . . . . . . . . . . . . . . . 522
Event of Undetermined Intent
(Category Codes Y21–Y33). . . . . 444 Chapter Review. . . . . . . . . . . . . . 476 Section. . . . . . . . . . . . . . . . . . . . . . 522
Legal Intervention, Operations of War, Coding Assignments. . . . . . . . . . 477 Body System . . . . . . . . . . . . . . . . . 522
Military Operations, and Terrorism Root Operation. . . . . . . . . . . . . . . . 523
Case Studies. . . . . . . . . . . . . . . . 478
(Category Codes Y35–Y38). . . . . 444 Body Part. . . . . . . . . . . . . . . . . . . . 523
Complications of Medical and Approach . . . . . . . . . . . . . . . . . . . . 523
Surgical Care (Category Codes Chapter 27: Introduction Device. . . . . . . . . . . . . . . . . . . . . . . 524
Y62–Y84) . . . . . . . . . . . . . . . . . . . 444 to ICD-10-PCS 482 Qualifier . . . . . . . . . . . . . . . . . . . . . 524
Supplementary Factors Related to Procedure Highlights . . . . . . . . . 526
Causes of Morbidity Classified Introduction . . . . . . . . . . . . . . . . 483
Abortion. . . . . . . . . . . . . . . . . . . . . 526
Elsewhere (Category Codes Code Structure. . . . . . . . . . . . . . 483
Y90–Y99). . . . . . . . . . . . . . . . . . . 445 Amniocentesis. . . . . . . . . . . . . . . . 526
Format. . . . . . . . . . . . . . . . . . . . . 484 Delivery. . . . . . . . . . . . . . . . . . . . . . 526
Summary. . . . . . . . . . . . . . . . . . . 448
Introduction . . . . . . . . . . . . . . . . . . 484 Cesarean Deliveries. . . . . . . . . . . . 526
Chapter Review. . . . . . . . . . . . . . 448
Index. . . . . . . . . . . . . . . . . . . . . . . . 485 Forceps Extraction. . . . . . . . . . . . . 526
Coding Assignments. . . . . . . . . . 450 Tables. . . . . . . . . . . . . . . . . . . . . . . 486 Summary. . . . . . . . . . . . . . . . . . . 528
Case Studies. . . . . . . . . . . . . . . . 451 ICD-10-PCS Coding Guidelines . . 487 Internet Links . . . . . . . . . . . . . . . 528
Selection of Principal Procedure . . . 489
Chapter 26: Factors Summary. . . . . . . . . . . . . . . . . . . 490
Chapter Review. . . . . . . . . . . . . . 528
Influencing Health Status Chapter Review. . . . . . . . . . . . . . 490
and Contact with Health Case Studies. . . . . . . . . . . . . . . . 529
Services 454 Chapter 28: Medical and
Surgical Section 493 Chapter 30: Placement
Introduction . . . . . . . . . . . . . . . . 455 Section 532
Introduction to Z Codes. . . . . . . 455 Introduction . . . . . . . . . . . . . . . . 494
Persons Encountering Health Introduction . . . . . . . . . . . . . . . . 533
Medical and Surgical Section
Services for Examinations Character Meanings. . . . . . . . . . 494 Placement Section of the
(Category Codes Z00–Z13). . . . . 456 ICD-10-PCS. . . . . . . . . . . . . . . . . 533
Section. . . . . . . . . . . . . . . . . . . . . . 494
Genetic Carrier and Genetic Section. . . . . . . . . . . . . . . . . . . . . . 533
Body Systems . . . . . . . . . . . . . . . . 494
Susceptibility to Disease Body System: Anatomical Regions
(Category Codes Z14–Z15). . . . . 460 ICD-10-PCS Official Coding
Guidelines Relating to Body and Anatomical Orifices. . . . . . . 533
Resistance to Antimicrobial Root Operation. . . . . . . . . . . . . . . . 533
System. . . . . . . . . . . . . . . . . . . . . 495
Drugs (Category Code Z16) . . . . 463 Body Part: Regions and Orifices. . . . 533
Root Operations. . . . . . . . . . . . . . . 496
Estrogen Receptor Status Approach . . . . . . . . . . . . . . . . . . . . 533
(Category Code Z17). . . . . . . . . . 463 ICD-10-PCS Official Coding
Guidelines Relating to Root Device. . . . . . . . . . . . . . . . . . . . . . . 535
Persons with Potential Health Operation. . . . . . . . . . . . . . . . . . . 501 Qualifier . . . . . . . . . . . . . . . . . . . . . 535
Hazards Related to Communicable
Diseases (Category Codes Body Part. . . . . . . . . . . . . . . . . . . . 506 Procedure Highlights . . . . . . . . . 535
Z20–Z29). . . . . . . . . . . . . . . . . . . 463 ICD-10-PCS Official Coding Cast Application. . . . . . . . . . . . . . . 535
Persons Encountering Health Guidelines Relating to Body
Dressing Application . . . . . . . . . . . 536
Services in Circumstances Related Part . . . . . . . . . . . . . . . . . . . . . . . 507
Packing. . . . . . . . . . . . . . . . . . . . . . 536
to Reproduction (Category Codes Approach . . . . . . . . . . . . . . . . . . . . 509
Summary. . . . . . . . . . . . . . . . . . . 536
Z30–Z39). . . . . . . . . . . . . . . . . . . 464 ICD-10-PCS Official Coding Guidelines
Encounters for Other Specific Relating to Approach. . . . . . . . . . . . 510 Internet Link . . . . . . . . . . . . . . . . 536
Health Care (Category Codes Device. . . . . . . . . . . . . . . . . . . . . . . 511 Chapter Review. . . . . . . . . . . . . . 536
Z40–Z53). . . . . . . . . . . . . . . . . . . 466 ICD-10-PCS Official Coding Coding Assignments. . . . . . . . . . 537
Persons with Potential Health Guidelines Relating to Device. . . 511
Case Studies. . . . . . . . . . . . . . . . 537
Hazards Related to Socioeconomic Qualifier . . . . . . . . . . . . . . . . . . . . . 512
xii TABLE OF CONTENTS
Chapter 31: Administration Duration . . . . . . . . . . . . . . . . . . . . . 560 Chapter 36: Physical

Function. . . . . . . . . . . . . . . . . . . . . 560
Section 539 Qualifier . . . . . . . . . . . . . . . . . . . . . 560
Rehabilitation and
Introduction �� 539 Summary. . . . . . . . . . . . . . . . . . . 561 Diagnostic Audiology
Administration Section of Chapter Review. . . . . . . . . . . . . . 561 Section 584
the ICD-10-PCS. . . . . . . . . . . . . . 540 Coding Assignments. . . . . . . . . . 562
Section. . . . . . . . . . . . . . . . . . . . . . 540 Case Studies. . . . . . . . . . . . . . . . 562
Physical Rehabilitation and
Body System: Physiological Systems Diagnostic Audiology Section. . . 585
and Anatomical Regions. . . . . . . 540 Chapter 34: Osteopathic, Section Qualifier. . . . . . . . . . . . . . . 585
Root Operation. . . . . . . . . . . . . . . . 540 Other Procedures, and Type . . . . . . . . . . . . . . . . . . . . . . . . 585
Body/System Region. . . . . . . . . . . 540
Approach. . . . . . . . . . . . . . . . . . . . 541
Chiropractic Sections 564 Body System and Region . . . . . . . 585
Type Qualifier. . . . . . . . . . . . . . . . . 586
Substance . . . . . . . . . . . . . . . . . . . 542 Introduction �� 565 Equipment and Qualifier . . . . . . . . 586
Qualifier . . . . . . . . . . . . . . . . . . . . . 542 Osteopathic Section�� 565 Summary. . . . . . . . . . . . . . . . . . . 587
Summary. . . . . . . . . . . . . . . . . . . 545
Anatomical Region and Root Internet Links . . . . . . . . . . . . . . . 587
Chapter Review. . . . . . . . . . . . . . 546 Operation. . . . . . . . . . . . . . . . . . . 565 Chapter Review. . . . . . . . . . . . . . 587
Coding Assignments. . . . . . . . . . 546 Body Region. . . . . . . . . . . . . . . . . . 565
Case Studies. . . . . . . . . . . . . . . . 547 Approach, Method, and
Qualifier. . . . . . . . . . . . . . . . . . . . 565 Case Studies. . . . . . . . . . . . . . . . 588
Chapter 32: Other Procedures. . . . . . . . . . . . 566
Chapter 37: Mental
Measurement and Root Operation. . . . . . . . . . . . . . . . 566
Health and Substance
Body Region. . . . . . . . . . . . . . . . . . 566
Monitoring Section 549 Approach . . . . . . . . . . . . . . . . . . . . 566 Abuse Treatment 590
Introduction �� 550 Method. . . . . . . . . . . . . . . . . . . . . . 567
Introduction ��591
Qualifier . . . . . . . . . . . . . . . . . . . . . 567
Measurement and Monitoring Mental Health Section . . . . . . . . 591
Section of the ICD-10-PCS�� 550 Chiropractic Section. . . . . . . . . . 568
Type . . . . . . . . . . . . . . . . . . . . . . . . 591
Section. . . . . . . . . . . . . . . . . . . . . . 550 Root Operation. . . . . . . . . . . . . . . . 568
Qualifier . . . . . . . . . . . . . . . . . . . . . 592
Body System . . . . . . . . . . . . . . . . . 550 Body Region. . . . . . . . . . . . . . . . . . 568
Qualifier . . . . . . . . . . . . . . . . . . . . . 593
Root Operation. . . . . . . . . . . . . . . . 550 Approach, Method, Qualifier. . . . . 568
Substance Abuse Treatment
Body System . . . . . . . . . . . . . . . . . 550 Summary. . . . . . . . . . . . . . . . . . . 568
Section . . . . . . . . . . . . . . . . . . . . 593
Approach. . . . . . . . . . . . . . . . . . . . 550 Internet Links . . . . . . . . . . . . . . . 569
Type . . . . . . . . . . . . . . . . . . . . . . . . 593
Function. . . . . . . . . . . . . . . . . . . . . 551 Chapter Review. . . . . . . . . . . . . . 569 Qualifier . . . . . . . . . . . . . . . . . . . . . 594
Qualifier . . . . . . . . . . . . . . . . . . . . . 552 Coding Assignments. . . . . . . . . . 569 Qualifiers . . . . . . . . . . . . . . . . . . . . 594
Summary. . . . . . . . . . . . . . . . . . . 553 Case Studies. . . . . . . . . . . . . . . . 570 Summary. . . . . . . . . . . . . . . . . . . 594
Chapter Review. . . . . . . . . . . . . . 553 Internet Links . . . . . . . . . . . . . . . 595
Coding Assignments. . . . . . . . . . 553 Chapter 35: Imaging, Chapter Review. . . . . . . . . . . . . . 595
Case Studies. . . . . . . . . . . . . . . . 554 Nuclear Medicine, and Coding Assignments. . . . . . . . . . 596
Radiation Therapy Case Studies. . . . . . . . . . . . . . . . 597
Chapter 33: Sections 572
Extracorporeal or Chapter 38: New
Systemic Assistance Introduction . . . . . . . . . . . . . . . . 573 Technology Section 599
and Performance and Imaging Section . . . . . . . . . . . . . 573
Extracorporeal or Body System and Type . . . . . . . . .
Body Part. . . . . . . . . . . . . . . . . . . .
573
573 New Technology Section Character
Systemic Therapies Contrast. . . . . . . . . . . . . . . . . . . . . 574 Meanings. . . . . . . . . . . . . . . . . . . 600
Sections 556 Qualifier . . . . . . . . . . . . . . . . . . . . . 574 Section Organization. . . . . . . . . . . 600
Nuclear Medicine Section. . . . . . 575 Body System . . . . . . . . . . . . . . . . . 600
Introduction ��557 Root Operation . . . . . . . . . . . . . . . 600
Body System . . . . . . . . . . . . . . . . . 575
Extracorporeal or Systemic Body Part. . . . . . . . . . . . . . . . . . . . 601
Type . . . . . . . . . . . . . . . . . . . . . . . . 575
Assistance and Performance Approach . . . . . . . . . . . . . . . . . . . . 601
Section of ICD-10-PCS. . . . . . . . 557 Body Part or Region . . . . . . . . . . . 575
Radionuclide . . . . . . . . . . . . . . . . . 576 Device/Substance/Technology. . . 601
Section. . . . . . . . . . . . . . . . . . . . . . 557 Qualifier . . . . . . . . . . . . . . . . . . . . . 602
Qualifier . . . . . . . . . . . . . . . . . . . . . 576
Body System/Physiological System. 557 Coding Guidelines for Section X of
Radiation Therapy Section. . . . . 577
Root Operation. . . . . . . . . . . . . . . . 557 ICD-10-PCS. . . . . . . . . . . . . . . . . 602
Body System . . . . . . . . . . . . . . . . . 558 Body System . . . . . . . . . . . . . . . . . 578
Summary. . . . . . . . . . . . . . . . . . . 602
Duration. . . . . . . . . . . . . . . . . . . . . 558 Modality. . . . . . . . . . . . . . . . . . . . . 578
Treatment Site . . . . . . . . . . . . . . . . 578 Internet Links . . . . . . . . . . . . . . . 603
Function. . . . . . . . . . . . . . . . . . . . . 559
Modality Qualifier. . . . . . . . . . . . . . 579 Chapter Review. . . . . . . . . . . . . . 603
Qualifier . . . . . . . . . . . . . . . . . . . . . 559
Isotope. . . . . . . . . . . . . . . . . . . . . . 579 Coding Assignments. . . . . . . . . . 603
Extracorporeal or Systemic
Qualifier . . . . . . . . . . . . . . . . . . . . . 579 Appendix A This appears in the
Therapies Section of
ICD-10-PCS�� 559 Summary. . . . . . . . . . . . . . . . . . . 580
MINDTAP & Student Companion Site
Section. . . . . . . . . . . . . . . . . . . . . . 559 Internet Links . . . . . . . . . . . . . . . 580
Chapter Review. . . . . . . . . . . . . . 580
Appendix B This appears in the
Body System/Physiological
System. . . . . . . . . . . . . . . . . . . . . 559 MINDTAP & Student Companion Site
Root Operation. . . . . . . . . . . . . . . . 559 Glossary 604
Case Studies. . . . . . . . . . . . . . . . 582
Body System . . . . . . . . . . . . . . . . . 560 Index 618
PREFACE
Understanding ICD-10-CM and ICD-10-PCS: A Worktext, 2020 Edition, provides a comprehensive textbook
to learn and master ICD-10-CM and ICD-10-PCS coding. This book can be used to instruct learners in both
academic and clinical settings. Its design helps coders transition to the new coding system.
The ICD-10-CM Official Coding Guidelines for Coding and Reporting are highlighted in various book chapters,
and the complete guidelines are contained in the appendix which is found in MINDTAP. Numerous clinical
examples and case studies are used throughout the book to provide opportunities for learners to practice with
real-life scenarios. Frequently encountered diseases are highlighted to enable the learner to become familiar with
common disease signs and symptoms, clinical testing, and treatments.
This updated printing of the 2020 edition includes new 2020 ICD-10-CM and ICD-10-PCS codes.
Organization of the Worktext

Several features are incorporated into the chapters to facilitate learning:
●● A chapter outline gives a brief overview of chapter content.
●● Learning objectives familiarize the learner with chapter objectives.
●● Key terms are listed at the start of each chapter and then highlighted and defined within the chapter.
●● Many clinical examples are used throughout the text.
●● Illustrations of human anatomy appear, based on the concept that learning is enhanced through visual
tools.
●● Coding assignments and case studies are used to determine comprehension of the material and to
provide real-world practice.
●● Chapter summaries review the main ideas for review purposes.
●● Internet links provide additional reference materials for the learner and take learning beyond the textbook.
●● Chapter reviews contain questions to reinforce content presented.
New to the 2020 Edition

●● The most current code sets available at the time of publication
●● Updated information from the 2020 ICD-10-CM and ICD-10-PCS Official Coding Guidelines for Coding and
Reporting
●● Chapter Review questions specifically designed to thoroughly test students’ understanding of the latest
2020 coding guidelines
Teaching Package for the Instructor

The following supplements are available online to enhance the use of Understanding ICD-10-CM and ICD-10-PCS:
A Worktext, 2020 Edition. All instructor resources can be accessed by going to www.cengage.com to create
a unique user login. Contact your sales representative for more information. Online instructor resources at the
Instructor Companion Website are password-protected and include the following:
xiii
xiv Preface
Instructor Resources
Spend less time planning and more time teaching with Cengage Learning’s Instructor Resources to Accompany
the 2020 Edition of Understanding ICD-10-CM and ICD-10-PCS. As an instructor, you will find these materials offer
invaluable assistance by giving you access to all of your resources, anywhere, at any time.
Features of the Instructor Resources include:
●● Customizable presentations for each chapter, written in Microsoft PowerPoint™
●● The Instructor’s Manual, which contains class preparation information and complete answer keys for each
chapter of the book.
Instructor’s Manual
Posted on the Instructor Companion Site in Adobe’s PDF format. Section I of the Instructor’s Manual features a
15-week lesson plan plus a course outline that can be modified to suit your course. Section II contains answer
keys to the exercises, chapter reviews, coding assignments, and case studies that appear in the textbook.
Computerized Test Bank

Cengage Learning Testing Powered by Cognero is a flexible, online system that allows you to:
●● author, edit, and manage test bank content from multiple Cengage Learning solutions
●● create multiple test versions in an instant
●● deliver tests from your LMS, your classroom, or wherever you want.
Cengage Learning Testing Powered by Cognero works on any operating system or browser.
●● No special installs or downloads needed.
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false, multiple choice, opinion scale/Likert, and essay). Multi-language support, an equation editor, and
unlimited metadata help ensure your tests are complete and compliant.
●● Cross-compatible capability. Import and export content into other systems.
MINDTAP
On the MINDTAP platform in the new Understanding ICD-10-CM and ICD-10-PCS: A Worktext, 2020 Edition,
instructors customize the learning path by selecting Cengage resources and adding their own content via apps
that integrate into the MINDTAP framework seamlessly with many learning management systems. The guided
learning path demonstrates the relevance of basic principles in coding through interactive exercises, elevating the
study by challenging students to apply concepts to practice. To learn more, visit www.cengage.com/mindtap.
Learning Package for the Student

Student Companion Website
Additional textbook resources for students can be found online by creating an account at http://login.cengage.
com. All resources located on the Student Companion Website to accompany Understanding ICD-10-CM and
ICD-10-PCS: A Worktext, 2020 Edition are free to textbook users.
MINDTAP
ISBN: 978-0-357-37861-8 (electronic access code)/ 978-0-357-37862-5 (printed access card)
MINDTAP is the first of its kind in an entirely new category: the Personalized Learning Experience (PLE). This
personalized program of digital products and services uses interactivity and customization to engage students,
Preface xv
while offering a range of choice in content, platforms, devices, and learning tools. MINDTAP is device agnostic,
meaning that it will work with any platform or learning management system, and will be accessible anytime,
anywhere: on desktops, laptops, tablets, mobile phones, and other Internet-enabled devices. Understanding
ICD-10-CM and ICD-10-PCS: A Worktext, 2020 Edition, on MINDTAP includes:
●● An interactive eBook with highlighting, note-taking functions, and more
●● Flashcards for practicing chapter terms
●● Computer-graded activities and exercises
●● Case studies
●● Medical Coding Trainer
Optum360® EncoderPro.com
Enhance your course with Cengage learning materials and online coding tools from Optum360®. EncoderPro.
com Expert is an online coding and reference tool designed to enhance your coding capabilities.
●● Using online coding tools can help by: saving you time and money;
●● increasing accuracy, reducing denials, and ensuring you receive complete reimbursement; and
●● reducing required storage space and paper.
Features of EncoderPro.com Expert include:
●● ICD-10-CM code content search
●● ICD-10 mapping tools
●● Coders’ Desk Reference
●● Complete code history
●● Local Coverage Determinations (LCDs) and Medicare Pub. 100 access
●● Medicare CCI edits
●● Modifier crosswalk
●● Enhanced compliance editor
●● Enhanced LCD/NCD policy searching
●● Cross-coder relationships from seven coding and billing specialty reference books
To make the switch and start saving on coding materials with Cengage and Optum360®, contact your Cengage
Learning Consultant today at cengage.com/repfinder.
ACKNOWLEDGMENTS
A special thank-you is extended to the reviewers who have provided recommendations to enhance the content of
this work.
Dr. Tammie Bolling Betty Haar, BS, RHIA Keita Kornegay, CEHRS,
Associate Professor Program Director CMAA, CMRS
Pellissippi State Community Kirkwood Community College Professor
College Cedar Rapids, Iowa Wilson Community College
Knoxville, Tennessee Wilson, North Carolina
Judy Hurtt, MEd
Mary M. Cantwell, Instructor Kathleen O’Gorman,
RHIT, CPC, CPC-H, CPC-I, East Central Community BS, CPC
CPC-P College Lead Instructor,
Professor Decatur, Mississippi Health Claims Program
Metro Community College Branford Hall Career Institute
Omaha, Nebraska Natasha Johnson, RHIT Southington, Connecticut
Health Information Management
NaTunya Davis Johnson Clinical Coordinator Angela P. Rein, RMA, AS,
Instructor, Business & Office Midlands Technical College BSHM, CPC, MAHS, CPC-H
Technology Department Columbia, South Carolina Medical Billing and Coding
Holmes Community College Department Chairperson
Ridgeland, Mississippi Pat King, MA, RHIA Sanford-Brown College
MIS System Program Coordinator Collinsville, Illinois
Robin Douglas and Adjunct Faculty
Health Care Data Technology Baker College Danielle Robel, MBA, BA,
Instructor Auburn Hills, Michigan medical assistant
Holmes Community College Adjunct Professor, School of Health
Grenada, Mississippi Lindsey Klimek, CPC, CIMC Sciences
Instructor Kaplan University
Melanie Endicott, MBA/HCM, Alexandria Technical and Fort Lauderdale, Florida
RHIA, CCS, CCS-P Community College
HIM Program Director Alexandria, Minnesota
Spokane Community College
Spokane, Washington
Rashmi Gaonkar, MS
Senior Instructor/Subject Specialist
ASA Institute
Brooklyn, New York
Technical Reviewer
Both Mary Jo and the Cengage Learning team offer their profound thanks to Lou Ann Decker for her significant
technical review efforts. Your efforts were invaluable on this revision. Many thanks for all that you do!
Lou Ann Decker, AAS, RHIT
xvi
ABOUT THE AUTHOR
Mary Jo Bowie, MS, BS, AAS, RHIA, RHIT

Mary Jo has worked in the health information field for more than 38 years as a consultant, HIM department
director, and college HIM and medical coding program director and associate professor and instructor. As
consultant and owner of Health Information Professional Services in Binghamton, New York, she has consulted
nationally in various levels of care, including inpatient hospital settings, ambulatory care settings, skilled nursing
facilities, physician offices, and clinics. She is an active member of the American Health Information Management
Association (AHIMA). She has held the following positions in the New York Health Information Management
Association: education director and a member of the board of directors, and Ambulatory Care Coding Guidelines
Committee chairperson. At the collegiate level, teaching both in the classroom and in an Internet-based format,
she has taught numerous health information technology and coding and reimbursement courses. Mary Jo
also conducts professional coding workshops for coders as well as for physicians and clinical staff. She is also
an AHIMA-approved ICD-10-CM and ICD-10-PCS Train the Trainer. She has led more than 60 workshops for
Cengage on ICD-10-CM and ICD-10-PCS.
xvii
CHAPTER
Introduction to Coding
and Coding Professions 1
Chapter Outline
Chapter Objectives Professional Coding Associations
Key Terms Employment Opportunities for Coders
Introduction Summary
Professional Coding Internet Links
History of Coding Chapter Review
Health Insurance Portability
and Accountability Act of 1996
Chapter Objectives
At the conclusion of this chapter, you should be able to:
1. Describe the purpose of coding.
2. Explain the development of the ICD classification system.
3. Discuss the standards mandated by the Health Insurance Portability and Accountability
Act of 1996.
4. Describe professional associations with reference to their certifications, requirements, and
purpose.
5. Identify the employment opportunities for coders.
Key Terms
Accrediting Bureau American Health Centers for Medicare Certified Documentation
of Health Education Information and Medicaid Services Improvement
Schools (ABHES) Management (CMS) Practitioner
Administrative Association Certified Coding (CDIP)
Simplification (AHIMA) Associate (CCA) Certified Health Data
American Academy of American Medical Certified Coding Analyst (CHDA)
Professional Coders Billing Association Specialist (CCS) Certified in Healthcare
(AAPC) (AMBA) Privacy and Security
Certified Coding
American Association American Medical Specialist, Physician- (CHPS)
of Medical Assistants Technologists Based (CCS-P) Certified Inpatient Coder
(AAMA) (AMT) (CIC)
(continues)
2 CHAPTER 1: Introduction to Coding and Coding Professions
Key Terms (continued )

Certified Medical Coding International National Center for Health
Assistant (CMA) Commission on Classification of Statistics (NCHS)
Certified Medical Billing Accreditation of Allied Diseases, Tenth Registered Health
Specialist (CMBS) Health Education Revision, Clinical Information
Programs (CAAHEP) Modification Administrator (RHIA)
Certified Medical Record
(ICD-10-CM)
Technician (CMRT) Health Insurance Registered Health
Portability and International Information Technician
Certified Medical
Accountability Act Classification (RHIT)
Reimbursement
of 1996 (HIPAA), Public of Diseases,
Specialist (CMRS) Registered Medical
Law 104-191 Tenth Revision
Certified Outpatient Assistant (RMA)
(ICD-10)
Coder (COC) ICD-10-CM World Health
Medical Association
Certified Professional ICD-10-PCS Organization (WHO)
of Billers (MAB)
Coder (CPC) ICD-10 Procedure
Morbidity
Certified Risk Adjustment Coding System
Mortality
Coder (CRC)
Introduction
Medical coding is the assignment of numeric or alphanumeric digits and characters to specific diagnostic and
procedural phrases. This coding, like any other language, needs to be translated to be understood, and each
combination of numbers or of numbers and letters represents a diagnostic or procedural phrase.
EXAMPLE: The diagnostic phrase “appendicitis” is translated into diagnostic code K37 in the ICD-10-CM coding system. The
procedural phrase “open total appendectomy” is translated into procedure code 0DTJ0ZZ in ICD-10-PCS.
By using ICD-10-CM and ICD-10-PCS codes, health care professionals can effectively collect, process, and
analyze diagnostic and procedural information.
Professional Coding
Coding is the language used by insurance companies and health care providers to describe what brought a
person to a facility for treatment and what services were performed. The ability of health care professionals to
communicate and translate these codes is vital to the care and treatment rendered to the patient. These codes
are also communicated to the insurance company, which is required to make payment for the patient’s care. All
involved parties must be able to understand and fluently “speak” the coding language to convey the essence of
the patient’s visit and treatment.
In the chapters that follow, the student will gain a greater knowledge of the language of coding, specifically
ICD-10-CM and ICD-10-PCS. By the completion of this book, the student will have the knowledge base needed
to become fluent in the language of ICD-10-CM and ICD-10-PCS coding, which is an ever-increasingly used tool
in the health care industry.
History of Coding
ICD-10-CM, an abbreviation for the International Classification of Diseases, Tenth Revision, Clinical
Modification, is an arrangement of classes or groups of diagnoses by systematic division that is used in the
United States. ICD-10-CM is based on the official version of the International Classification of Diseases, Tenth
CHAPTER 1: Introduction to Coding and Coding Professions 3
Revision (ICD-10), which was developed by the World Health Organization (WHO) in Geneva, Switzerland.
ICD-10 is used throughout the world as a standard diagnostic tool for epidemiology, health management, and
clinical purposes. In 1948, the WHO assumed responsibility for preparing and publishing the revisions to the ICD
every 10 years. Thus, with every 10-year revision, the name of the current ICD changes.
EXAMPLE: ICD-8 was revised to become ICD-9; ICD-9 was revised to become ICD-10. An ICD-11 version for preparing
implementation in Member States, including translations, was released on June 18 2018. During 2019 ICD-11 was
presented at the Seventy-second Work Health Assembly. At this current time it is anticipated that the Member States of
the World Health Organization will begin reporting health data using ICD-11 in January of 2022. For the most up-to-date
information on ICD-11, visit http://www.who.int/classifications/icd/revision/en/. This website contains a wealth of
information about ICD-11.
The ICD classification system was designed to compile and present statistical data on morbidity (the
rate or frequency of disease) and mortality (the rate or frequency of deaths). Hospitals first used this form of
classification to track, store, and retrieve statistical information. However, a more efficient basis for the storage
and retrieval of diagnostic data was needed. In 1950, the Veterans Administration and the U.S. Public Health
Service began independent studies of the use of the ICD for hospital indexing purposes. By 1956, the American
Hospital Association and the American Association of Medical Record Librarians (now the American Health
Information Management Association) felt that the ICD form of classification provided an efficient and useful
vehicle for indexing hospital records.
With hospital indexing in mind, the WHO international conference published its eighth revision of the ICD
in 1966. Health care professionals in some countries found that ICD-8 lacked the detail needed for diagnostic
indexing. In the United States, consultants were asked to study ICD-8 for its applicability to various users. In
1968, the Advisory Committee to the Central Office on ICD published the International Classification of Diseases,
Eighth Revision, adapted for use in the United States. It became known as ICDA-8 and was used for coding
diagnostic data for both morbidity and mortality statistics in the United States.
In 1979, ICD-9-CM replaced earlier, less-specific versions of the classification system. ICD-9-CM
streamlined the other versions of ICD classification into a single system that was intended for use primarily in
U.S. hospitals. Please note that there is a difference between ICD-9 and ICD-9-CM. ICD-9 was developed
by the WHO, and in the United States we take the ICD-9 version and modify codes to create the clinical
modification of ICD-9 that will be used within the United States. The ICD-9-CM provided a more complete
classification system for morbidity data to be used for indexing and reviewing patient records and medical
care.
In 1992, the WHO published ICD-10, which is currently being used in many countries. In 1997, the National
Center for Health Statistics (NCHS) began testing the ICD-10 system for implementation of the diagnostic codes
in the United States. In the United States, the ICD codes are further developed into ICD-10-CM codes, which is
the clinical modification of ICD codes. This modification allows for the ICD-10-CM codes to be more effectively
used in clinical settings to capture diseases and signs and symptoms that patients display. In the United States,
the National Center for Health Statistics (NCHS) is responsible for maintaining the ICD-10-CM diagnostic
codes.
As the NCHS was testing ICD-10-CM, the draft and the preliminary crossfunctionality between
ICD-9-CM and ICD-10-CM were made available on the NCHS website for public review and comment. In
the summer of 2003, the American Hospital Association and the American Health Information Management
Association conducted a field test for ICD-10-CM and reported the findings. Modifications were then made to the
tenth revision.
In 2001, the Centers for Medicare and Medicaid Services funded a project to design a replacement system for
the procedural codes of ICD-9-CM. The contract to redesign the procedural codes was awarded to 3M Health
Information Systems. The new system is known as ICD-10 Procedure Coding System or ICD-10-PCS. The
Centers for Medicare and Medicaid Services (CMS) is responsible for maintaining the procedure codes of
ICD-10-PCS.
4 CHAPTER 1: Introduction to Coding and Coding Professions
ICD-10-CM and ICD-10-PCS, when compared to ICD-9-CM, has additional information relevant to:
●● Ambulatory and managed-care encounters.
●● Expanded injury codes.
●● More combination diagnosis-symptom codes to reduce the number of codes needed to fully describe a
condition.
●● Expanded use of sixth and seventh characters.
●● Laterality and greater specificity in code assignment.
On August 22, 2008, the U.S. Department of Health and Human Services (HHS) published a proposed rule
to adopt ICD-10-CM and ICD-10-PCS to replace ICD-9-CM. On January 16, 2009, the final rule on adoption of
ICD-10-CM and ICD-10-PCS was published with an implementation date of October 1, 2013. During 2012 the
implementation date of October 1, 2013 was reviewed and extended to October 1, 2014. And again in 2014, the
implementation date was changed to October 1, 2015.
This system has become the key storyteller to the insurance companies, explaining what brought the patient
into the office or facility (by means of a diagnostic code), as well as what services the facility provided (by means
of a procedural code). Because coding plays such a critical role in the reimbursement for services rendered,
correct coding practices are essential.
Health Insurance Portability

and Accountability Act of 1996
The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, was
passed by Congress to improve the portability and continuity of health care coverage. The Administrative
Simplification aspect of this legislation developed standards for the electronic exchange of health care data
for administrative and financial transactions. The final rule on transactions and code sets mandated the use of
standardized code sets for the electronic submission of health care data.
HIPAA mandates that ICD-9-CM diagnostic codes must be reported for diagnoses for all levels of care,
including all hospital services, clinic services, long-term care, and physician offices. ICD-9-CM procedural
codes are to be reported for inpatient hospital services. Health care providers must use ICD-9-CM codes
to accurately report diagnoses and services provided on submitted insurance claims. The codes are used
to determine not only payment, but also the medical necessity of care, which is defined by Medicare as
“the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or
treatment of an illness or injury.” Thus, coders perform a vital role in the health care system.
ICD-10-CM and ICD-10-PCS codes replaced ICD-9-CM for use by inpatient facilities starting on October 1,
2015. Also on that date, ambulatory services and physician services started using ICD-10-CM codes for
diagnosis and continued to use CPT codes for procedures.
Professional Coding Associations

To assist and promote correct coding and reimbursement, several organizations educate, train, and credential
coders. Credentialing ensures the proper training and education of coders. As the transition is made from
ICD-9-CM to ICD-10-CM and ICD-10-PCS, many of the following professional organizations will be offering
educational materials to assist in the transition.
American Health Information Management Association (AHIMA)

The American Health Information Management Association (AHIMA) represents health information
professionals who manage, organize, process, and manipulate patient data. Health-information professionals
have knowledge of electronic and paper medical record systems, as well as of coding, reimbursement, and
CHAPTER 1: Introduction to Coding and Coding Professions 5
research methodologies. The information that these professionals manage directly impacts patient care and
financial decisions made in the health care industry. Members of AHIMA feel that the quality of patient care is
directly related to the effectiveness of the information available.
Health care providers, insurance companies, and institutional administrators depend on the accuracy and
quality of that information. For this reason, AHIMA members are trained to provide a level of service that maintains
the quality and accuracy of the medical information they come into contact with.
AHIMA offers a number of certifications and credentials to ensure that its members meet the level of
proficiency needed by educated professionals to manage health care information. Members receive the following
certifications or credentials through a combination of education, experience, and performance on national
certification examinations:
●● CCA—Certified Coding Associate
●● CCS—Certified Coding Specialist
●● CCS-P—Certified Coding Specialist, Physician-Based
●● CDIP—Certified Documentation Improvement Practitioner
●● CHDA—Certified Health Data Analyst
●● CHPS—Certified in Healthcare Privacy and Security
●● RHIA—Registered Health Information Administrator
●● RHIT—Registered Health Information Technician
Once the certifications have been obtained, continuing education credits are required to maintain them. These
credits can be obtained through conferences, seminars, classes, or other avenues of career development that
AHIMA publishes and makes available to its members.
American Academy of Professional Coders (AAPC)

The American Academy of Professional Coders (AAPC) was founded to elevate the standards of medical
coding. The AAPC provides networking opportunities through local chapter memberships and conferences. It
also provides ongoing educational opportunities for members. AHIMA deals with all aspects of health information,
whereas AAPC focuses on coding and reimbursement.
Like AHIMA, AAPC offers certifications for professional proficiency. The Certified Professional Coder (CPC)
certification validates a coder’s proficiency in the physician office setting, the Certified Inpatient Coder, (CIC)
certification validates proficiency in the inpatient hospital setting, and the Certified Outpatient Coder
(COC) certification validates coding proficiency in outpatient hospital and outpatient facility coding. The AAPC
also offers specialty credentials for experienced coders. To understand the various specialty coding examinations
and credentials review the following website: https://www.aapc.com/certification/specialty-credentials.aspx.
AAPC also offers the Certified Risk Adjustment Coder (CRC) certification that validates that a coder can
read a medical chart and assign the correct diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and
services for risk adjustment models. AAPC also offers specialty coding certifications. Information about these
and other certifications from AAPC can be found at https://www.aapc.com/certification/.
Continuing education credits are also required to maintain AAPC certification.
American Association of Medical Assistants (AAMA)

The American Association of Medical Assistants (AAMA) represents individuals trained in performing
routine administrative and clinical jobs, including coding, that keep medical offices and clinics running efficiently
and smoothly. Credentialing is voluntary in most states; a medical assistant is not required to be certified or
registered. However, the AAMA offers the national credential of Certified Medical Assistant (CMA) certification
for medical assistants. The Commission on Accreditation of Allied Health Education Programs (CAAHEP)
collaborates with the Curriculum Review Board of the AAMA Endowment to accredit medical assisting programs
in both public and private postsecondary institutions throughout the United States.
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Mutta jos metsäkyyhkynne karkaa.
PRINSSI
Ei pelkoa! Olen siltä varalta asettanut kujeilijani halkovajaan. — Ja

lopulta — vangitutan minä itseni.
OTRO
Ahaa, ymmärrän — metsänvartijan! Teidän viisautenne on

verraton kuten hyveenne ovat hiljaiset.
PRINSSI
Tahdon häntä hiukan hämmästyttää ja häikäistä. (Katsoo

ikkunasta.)
Kas, hän tulee jo kaivolta! Tahdon olla yksin. (Vetäytyy syrjään.)
OTRO
Ymmärrän, teidän korkeutenne! (Menee.)
IMANDRA (tulee kiireesti, astuu ikkunan luo ja alkaa kastella

kukkia, seisoo selin prinssiin.)
No, etkö mene halkoja hakkaamaan! Tässä kastelen "Kodin ilon"

kukkia, onpa tämäkin kodin iloa. Päivä menee taas pilveen.
PRINSSI
Taitaa tulla sade.
IMANDRA
Vai luuletko olevasi joku prinssi, jonka ei tarvitse tehdä mitään?
PRINSSI
Eivätkö prinssit tee mitään?
IMANDRA
Eivät tee muuta kuin huvittelevat ja kulkevat maita mantereita

kosiskellen onnettomia prinsessoja niinkuin se Kaukovallan
prinssikin.
PRINSSI (nauraen)
Hahhaa!
IMANDRA
Mitä naurettavaa siinä on?
PRINSSI
Onko se prinssi niin häijy?
IMANDRA
Häijy kuin synti. Mutta tulkoonpa toiste ryöstämään, niin kyllä minä
sen höyhennän! Taitaa sen korvat kuumottaa siitä korvapuustista,
minkä minä metsässä annoin.
PRINSSI (nauraen)
Taitaa niin kuumottaa, hahhaa!

IMANDRA
Oletko naurutautinen, vai mitä! Ala jo mennä, muuten saat sinäkin!
PRINSSI
Ai, ai!
IMANDRA
Niin, ai, ai! (Kääntyy kiljahtaen.) Ai, ai, prinssi! (Juoksee ympäri
tupaa, avaa luukun ja kätkeytyy kuoppaan.)
PRINSSI (luukun ääressä)
Sielläkö sinä olet? Mitä sinä siellä teet? Avaahan nyt hiukan!
IMANDRA (raottaa luukkua)
Minä vain haen porkkanoita.
PRINSSI
Sinä veitikka, eihän kuopassa ole porkkanoita. Miksi sinä juoksit

pakoon?
IMANDRA
Minä pelkäsin — aavetta.
PRINSSI
Olenko minä niin aaveen näköinen?

IMANDRA
Ei, ei, mutta kun minä luulin Metsä-Matin olevan tuvassa ja äkkiä
hän muuttui…
PRINSSI
Prinssiksi!
IMANDRA
Luulin, että tässä oli jotain taikaa.
PRINSSI
Onko sinulla joku taikakalu…?
IMANDRA
Ei, ei minulla ole. Minä en erottanut äänestä.
PRINSSI
Tulehan pois sieltä pimeästä, muuten siellä alkaa kummitella.
IMANDRA
En minä tule. En minä uskalla. (Vetää luukun kiinni.)
PRINSSI
Kuka sinä olet? Nouse nyt sieltä, muuten minä seison luukulla
siksi kunnes Metsä-Matti tulee. Avaa heti!
IMANDRA (avaa)
Voi, voi, prinssikulta, ettehän suuttunut.
PRINSSI
Kyllä minä suutun, jollet jo tule.
IMANDRA (nousee kuopasta, niijaa maalaisesti)
Minä häpeän niin, kun minä sanoin prinssiä häijyksi ja…
PRINSSI
Ja laiskaksi. Ah, en ollut sinua tuntea, minähän tapasin sinut

metsässä.
IMANDRA
Minä en olisi silloin tuntenut itseäni.
PRINSSI
Sinä olet se sama pesemätön paimentyttö, jota…
IMANDRA
Jota te luulitte noidaksi.
PRINSSI
Taisit hiukan noitua, koska minä unohdin itseni.

IMANDRA
Ei, ei, en minä noitunut. Minähän unohdin itseni, kun annoin…
PRINSSI
Aika korvapuustin, hahhaa! Että korvat vieläkin kuumottavat.
IMANDRA
Minun korvani kuumottavat sitä ajatellessani.
PRINSSI
Sinä olit uskollinen Metsä-Matillesi, et antanut suuta

prinssillekään.
IMANDRA
Miksi prinssi piti pilanaan?
PRINSSI
Sinä olit niin Suvikunnan prinsessan näköinen, etten voinut

vastustaa haluani.
IMANDRA
Olisikohan Suvikunnan prinsessa tehnyt samoin?
PRINSSI
Ehkä hän olisi hyppinyt harakkaa. Oh, minä en sääli häntä enään.
IMANDRA (pettyneenä)
Te ette siis muistele häntä enään.
PRINSSI
Minä vietän kohta häitä. Minä säälin tulevaa korkeata puolisoani.
IMANDRA
Sanotaan, että hän istuu mykkänä tornikomerossa.
PRINSSI
Kukaan ei saa häntä nähdä ennenkuin hää-iltana, silloin hänen

kielensä lumous laukeaa.
IMANDRA
Onko hän kauniimpi kuin — Suvikunnan prinsessa?
PRINSSI
Hän on nyt onneton ja se kaunistaa kaikkia.
IMANDRA
Olenko minä enään kaunis?
PRINSSI
Pikku narri! Sinä et ole onneton.

IMANDRA
Oi, minä olen niin onneton, minä tahtoisin kuolla!
PRINSSI
Olet olevinasi onneton. Kaikki nuoret neitoset haaveksivat häitä ja

kuolemaa. Etkö sinäkin ole onnellinen tässä pienessä mökissä?
IMANDRA
Minä en tiedä. Minä tahtoisin olla onnellinen.
PRINSSI
Eikö Metsä-Matti ole hyvä sinulle? Onko hän kovakourainen?
IMANDRA
Hän ei lyö ja toisinaan minä toivoisin, että hän löisi. Minä olen
sellainen! Minä tahtoisin, että hän hivelisi minun hiuksiani, koskisi
käsiäni niinkuin prinssi silloin metsässä…
PRINSSI
Mitä, mitä sinä makeilet? Minun käteni ovat nyt sidotut, minä en
saa muistaa…
IMANDRA
Ettekö muista…? Minä olisin tahtonut, että Metsä-Matti olisi minut

oikein ryöstänyt salaa yöllä linnanikkunasta.
PRINSSI
Vieläkö sinä haudot hullutuksiasi?
IMANDRA
Enkö minä sitten enään ole ryöstämisen arvoinen? Katsokaa,

käteni ovat nyt karkeat… Ei prinssikään niitä nyt koskisi.
PRINSSI
Kudo sinä vain kangastasi! Ompele siihen helmiä ja kalliita kiviä,

tähtiä ja lähteensilmiä, niin morsiameni ilostuu! — Vieläkö sinä istut
lähteellä ja katselet kuvaasi?
IMANDRA
Mitäpä minä katsoisin kun ei kukaan minua katsele!
PRINSSI
Minun täytyy sanoa Metsä-Matille, että hän katselee sinua

enemmän.
IMANDRA
Ei, ei, kyllä hän katselee minua usein salaa ja toisinaan nauraa
hän itsekseen. Hän on niin kummallinen ja kateenarka.
PRINSSI
Kelle?
IMANDRA
Prinssille.
PRINSSI
Minulle? Miksi niin?
IMANDRA
Kun te silloin metsässä… Oh, minä en uskalla sitä ajatella…
PRINSSI (katsellen kukkia)
Sinulla onkin nyt niin sirkut silmät ja sinä olet armas katsella kuin
tämä kodinilon kukka.
IMANDRA
Se on niin vaarallista, Matti on niin kiivas, hän voisi…
PRINSSI
Mitä?
IMANDRA
Unohtaa, että hän on prinssin palvelija.
PRINSSI
Uskaltaisiko hän nousta omaa herraansa ja hallitsijaansa vastaan?

Oh, tämä on niin naurettavaa! Minä en pelkää!
IMANDRA (veikeillen)
Ettekö pelkää enään minua, minun silmiäni? Tahdotteko, niin minä

tanssin teille?
PRINSSI
Mitä sinä tahdot? Älä vain hypi harakkaa!
IMANDRA
Hahhaa, niinkuin Suvikunnan prinsessa.
PRINSSI
Oh, sinä olet viehkeä kuin hän, vaarallinen kuin hän, sinä olet
vieno velho, sinä lumoat silmäni.
IMANDRA (välkyttelee peilin palasella niin, että päivänsäteet

valaisevat prinssin kasvoja.)
PRINSSI
Mitä sinä teet, sokaiset silmäni, näen valkoisia hiiriä lattialla!
IMANDRA
Päivän elohiiret tanssivat silmissänne. Kuuletteko? (Kuuluu huilun

soittoa.)
PRINSSI
Kuka soittaa?
IMANDRA
Metsä-Matti soittaa halkotarhassa.
PRINSSI
Metsä-Matti?
IMANDRA
Minä pelkään… Hän hioo kirvestään.
PRINSSI
Kirvestään? Mitä varten?
IMANDRA
Armollinen prinssi! Älkää panko Mattia vesitynnyriin!
PRINSSI
Mitä hän aikoo? En ymmärrä… Sinä vedät minua kuin virta. Noita!
IMANDRA
Enkö ole ihana?
PRINSSI
Ah, ihana! Tanssi, tanssi!
IMANDRA
Minä tanssin teidän sydämeenne.
PRINSSI
Sinä olet sydämetön, minulla ei ole enään sydäntä, tyhjä paikka,

pimeys!
IMANDRA
Ettekö muista Imandraa!
PRINSSI
Ah, muistan!
IMANDRA
Ja olette unohtanut sen uuden prinsessan? Ah, minä olen

kateellinen hänelle.
PRINSSI
En muista, sinun huulesi hurmaavat. Tanssi, tanssi!
IMANDRA
Minä tanssin!
PRINSSI
Sinun kätesi kimmeltää kuin kristalli, mitä sinulla on?
IMANDRA (asettaa peilin prinssin kasvojen eteen)

Taikapeili!
PRINSSI
Oh, kuinka minä olen ruma, minä olen hukassa! Missä minä olen?
En tunne itseäni, en sinua. Tule! (Prinssi aikoo syöksyä Imandran
syliin, joka väistyy tanssien.)
IMANDRA
Tulen häihin!
PRINSSI
Häihin? Nyt muistan morsiameni. Nyt muistan, mitä minä olen

tehnyt.
Pääni on pyörällä, minä tukehdun! Missä on ovi? Ilmaa, ilmaa!
(Juoksee ovesta.)
IMANDRA
Prinssi, tulkaa takaisin! Se oli vain pilaa. (Katsoo ikkunasta.) Hän

meni! Hm. (Asettuu kangaspuiden ääreen ja alkaa kutoa, laulaa.)
Nyt tornissa kutoo neitoset hääkultakangastaan,

ja morsiusneidot laulavat nyt armaastansa vaan.
Soi viimeisen kerran mun lempeni laulu!
Ne punoo pukuun helmiä ja kalliita kiviä,

ne punoo morsiuskruunua ja Indian silkkiä.
Ja ken ne helmet, kivet saa ja ken sen kruunun saa,
ei kukaan enään rakasta nyt kurjaa kutojaa!
En enään ilonpäiviä mä näe milloinkaan

ja suruhunnun kutoa nyt itselleni saan.
En helmiä, en kiviä mä siihen punoa saa,

on kyynelhelmet ainoat, joilla voin sen koristaa.
(Kuuluu sateen rapinaa katolla ja ikkunalla.) Uh! Kuka kolkutti?

(Menee avaamaan.)
HOVIHERRA (ja hovirouva)
Tästä, armollinen rouva! Ai! Löin pääni ovenkamanaan. Tänne

tullessa täytyy kumartaa.
HOVIROUVA
Niinkuin hovissa. Yh, pääsimmehän sateen suojaan. (Asettaa

tirkistyslasin silmilleen.) Mikä muunnos!
HOVIHERRA (rientää esille)
Prinsessa!
IMANDRA
Ah!
HOVIHERRA
Kenelle te kudotte noin kaunista kangasta?
IMANDRA
Kaukovallan prinssin tulevalle puolisolle.
HOVIROUVA
Mikä alennuksen askel!
HOVIHERRA
Niin, meitä on kutsuttu prinssin häihin.
HOVIROUVA
Ja tällaisessa harakanpesässä prinsessa nyt asuu!
IMANDRA
Ei tämä ole mikään harakanpesä!
HOVIROUVA
Siitä saitte, että hypitte harakkaa. Eikö nyt olisi ihanaa astua
kuninkaalliseen kultasaliin morsiuskruunu päässä? Eikö prinsessa
kadu?
IMANDRA
Mitäpä minä katuisin, en ole mielestäni mitään pahaa tehnyt.

HOVIROUVA (pirskoittaen hajuvettä)
Täällä on niin umpea ilma. Avatkaa ikkuna!
(Hoviherra avaa ikkunan.)
IMANDRA
Kaikkeen sitä tottuu.
HOVIROUVA
Mutta hovitapoihin oli vaikea tottua.
HOVIHERRA
Täällähän on sievää ja siistiä. Palkit ja seinät säihkyvät puhtautta.

Pieni porsliiniparatiisi!
HOVIROUVA
Peseekö prinsessa itse lattian?
IMANDRA
Kukapa sen pesisi!
HOVIROUVA
Prinsessa raataa kuin palkkapiika, mikä häväistys!
IMANDRA
Ei työ ole häpeäksi, sanoo Metsä-Matti.
HOVIHERRA
Ja puutarhassa tuoksuvat omenapuut!
IMANDRA
Mutta hajuvesi sekoittaa niiden tuoksun.
HOVIROUVA
Tiedättekö! Minun ruusuveteni on tuotu Indiasta saakka.
HOVIHERRA
Suurin ilomme olisi nähdä teidät taas keskellämme, kullatussa

kammiossanne, jonka olemme kaunistaneet.
IMANDRA
Mutta siellä on niin ikävä.
HOVIROUVA
Minä annan anteeksi prinsessan entiset erehdykset.
HOVIHERRA
Tuotamme hoviin iloisia soittoniekkoja, saatte hyppiä vaikka

harakkaa.
HOVIROUVA
Ei, ei, sen minä kiellän.
IMANDRA
Saan minä täälläkin tanssia ja Metsä-Matti soittaa. Äsken tanssin

prinssille.
HOVIROUVA
Kävikö hänen korkeutensa täällä, sepä ihme!
IMANDRA
Hän ei tunne minua.
HOVIROUVA
Sepä onni!
IMANDRA
Hän kutsui minua hoviin ompelemaan.
HOVIROUVA
Mutta prinsessa, ettekö nyt ajattele! Prinsessan pitäisi hävetä!
IMANDRA
Jotain täytyy tehdä elääkseen.
HOVIROUVA
Mikä se Metsä-Matti on miehiään? Kiusaa teitä nälälläkin, minäpä
sanon prinssille…
IMANDRA
Ei, ei, Metsä-Matti ei ole paha!
HOVIHERRA
Ehkä prinssi vielä muuttaa mieltään, kun hän tuntee teidät.
IMANDRA
Ehkä hän kerran tuntee. Pitäköön prinsessansa!
HOVIHERRA
Ehkä hän ihastuu ikihyväksi nähdessään tämän ihmeellisen

muutoksenne.
IMANDRA
Minä voin kerjätä leipääni, mutta minä en kerjää onneani.
HOVIHERRA
Onni tulee, onni menee. Ehkä se Metsä-Matti on loitsija.
HOVIROUVA
Se Metsä-Matti on veijari, se on pantava jalkapuuhun!
IMANDRA

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(eBook PDF) Understanding ICD-10-CM

and ICD-10-PCS: A Worktext - 2020 5th

Borderline Diagnosis . . . . . . . . . . . . 57 Infections with a Predominantly Malignant Neoplasm Without

Chapter 9: Endocrine, Disorders of Adult Personality and

Summary. . . . . . . . . . . . . . . . . . . 225 Chronic Lower Respiratory Diseases

Systemic Connective Tissue Summary. . . . . . . . . . . . . . . . . . . 333 Abnormal Findings on Neonatal

Introduction ������������������������������ 323 Delivery Problems (Category

Chapter 31: Administration Duration . . . . . . . . . . . . . . . . . . . . . 560 Chapter 36: Physical

Organization of the Worktext

New to the 2020 Edition

Teaching Package for the Instructor

Computerized Test Bank

Learning Package for the Student

Lou Ann Decker, AAS, RHIT

Mary Jo Bowie, MS, BS, AAS, RHIA, RHIT

Key Terms (continued )

Health Insurance Portability

Professional Coding Associations

American Health Information Management Association (AHIMA)

American Academy of Professional Coders (AAPC)

American Association of Medical Assistants (AAMA)

Ei pelkoa! Olen siltä varalta asettanut kujeilijani halkovajaan. — Ja

Ahaa, ymmärrän — metsänvartijan! Teidän viisautenne on

Tahdon häntä hiukan hämmästyttää ja häikäistä. (Katsoo

Ymmärrän, teidän korkeutenne! (Menee.)

IMANDRA (tulee kiireesti, astuu ikkunan luo ja alkaa kastella

No, etkö mene halkoja hakkaamaan! Tässä kastelen "Kodin ilon"

Taitaa tulla sade.

Eivätkö prinssit tee mitään?

Eivät tee muuta kuin huvittelevat ja kulkevat maita mantereita

Mitä naurettavaa siinä on?

Onko se prinssi niin häijy?

Taitaa niin kuumottaa, hahhaa!

Oletko naurutautinen, vai mitä! Ala jo mennä, muuten saat sinäkin!

PRINSSI (luukun ääressä)

IMANDRA (raottaa luukkua)

Minä vain haen porkkanoita.

Sinä veitikka, eihän kuopassa ole porkkanoita. Miksi sinä juoksit

Minä pelkäsin — aavetta.

Olenko minä niin aaveen näköinen?

Luulin, että tässä oli jotain taikaa.

Onko sinulla joku taikakalu…?

Ei, ei minulla ole. Minä en erottanut äänestä.

Tulehan pois sieltä pimeästä, muuten siellä alkaa kummitella.

En minä tule. En minä uskalla. (Vetää luukun kiinni.)

Voi, voi, prinssikulta, ettehän suuttunut.

Kyllä minä suutun, jollet jo tule.

IMANDRA (nousee kuopasta, niijaa maalaisesti)

Minä häpeän niin, kun minä sanoin prinssiä häijyksi ja…

Ja laiskaksi. Ah, en ollut sinua tuntea, minähän tapasin sinut

Minä en olisi silloin tuntenut itseäni.

Sinä olet se sama pesemätön paimentyttö, jota…

Jota te luulitte noidaksi.

Taisit hiukan noitua, koska minä unohdin itseni.

Ei, ei, en minä noitunut. Minähän unohdin itseni, kun annoin…

Aika korvapuustin, hahhaa! Että korvat vieläkin kuumottavat.

Minun korvani kuumottavat sitä ajatellessani.

Sinä olit uskollinen Metsä-Matillesi, et antanut suuta

Miksi prinssi piti pilanaan?

Sinä olit niin Suvikunnan prinsessan näköinen, etten voinut

Olisikohan Suvikunnan prinsessa tehnyt samoin?

Te ette siis muistele häntä enään.

Introduction �� 323 Delivery Problems (Category