The ICD-10 Transition: Focus on Non-Covered Entities

The ICD-9 code set used to report medical diagnoses and inpatient procedures is being replaced by the ICD-10 code set. To accommodate the ICD-10 code structure, the standards used for electronic health care transactions, Version 4010/4010A, were upgraded to Version 5010 on January 1, 2012.

ICD-10-CM Search Tool

Coding Novel Coronavirus: Type COVID-19

This document provides guidance on proper coding practices for a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19). Please note that Healthfirst guidelines related to waiving the cost share for evaluating a member for suspected COVID-19 are not reflected within this coding guidance. Please refer to the Coronavirus (COVID-19) section at hfproviders.org to find information on claims/encounters that will result in the waiver of cost sharing for members.

ICD-10 Coding FAQs

Created June 2015

The Source ICD-10 Special Edition

ICD-10 Codes Tobacco/Nicotine Dependence, and Secondhand Smoke Exposure

Rheumatoid Arthritis ICD-10-CM Diagnosis Codes

Documentation and Coding: Risk Adjustment

This tip sheet offers guidance on proper risk adjustment coding. Risk adjustment relies on correct ICD-10-CM diagnosis coding to represent the member’s health status and to establish an accurate risk score.

Documentation and Coding: Functional Quadriplegia

This tip sheet offers guidance on how to submit diagnosis codes for Functional Quadriplegia, which is defined as “the inability to move due to severe disability or frailty caused by another condition without physical injury or damage to the brain or spinal cord.”

Documentation and Coding: Protein-Calorie Malnutrition (PCM) or Protein-Energy Malnutrition (PEM)

To accurately code a patient as Protein-Calorie Malnutrition or Protein-Energy Malnutrition, the coder must document the diagnosis. Severity ranges from subclinical deficiencies to obvious wasting (with edema, hair loss, and skin atrophy) to starvation. Multiple organs are often impaired.

Documentation and Coding: Morbid Obesity

To accurately code a patient as morbidly obese, the provider must document the patient’s obesity in the medical record. Per 2020 ICD-10-CM Guidelines, “BMI codes should only be assigned when there is an associated, reportable diagnosis (such as morbid obesity). Do not assign BMI codes during pregnancy.”