Toxic effects of unspecified organic solvent

T52.9 Toxic effects of unspecified organic solvent

T52.91 Toxic effect of unspecified organic solvent, accidental (unintentional) 

T52.92 Toxic effect of unspecified organic solvent, intentional self-harm

T52.93 Toxic effect of unspecified organic solvent, assault 

T52.94 Toxic effect of unspecified organic solvent, undetermined 

T56 Toxic effect of metals 

T56.0 Toxic effects of lead and its compounds 

T56.0X Toxic effects of lead and its compounds 

T56.0X1 Toxic effects of lead and its compounds, accidental (unintentional) 

T56.0X2 Toxic effects of lead and its compounds intentional self-harm 

T56.0X3 Toxic effects of lead and its compounds, assault

T56.0X4 Toxic effects of lead and its compounds, undetermined 

T56.1 Toxic effects of mercury and its compounds 

T56.1X Toxic effects of mercury and its compounds 

T56.1X1 Toxic effects of mercury and its compounds, accidental (unintentional) 

T56.1X2 Toxic effects of mercury and its compounds, intentional self-harm 

T56.1X3 Toxic effect of mercury and its compounds, assault

T56.1X4 Toxic effect of mercury and its compounds, undetermined 

T56.8 Toxic effects of other metals 

T56.89 Toxic effects of other metals 

T56.891 Toxic effect of other metals, accidental (unintentional)

T56.892 Toxic effect of other metals, intentional self-harm 

T56.893 Toxic effect of other metals, assault 

T56.894 Toxic effect of other metals, undetermined 

T56.9 Toxic effects of unspecified metal 

T56.91 Toxic effect of unspecified metal, accidental (unintentional) 

T56.92 Toxic effect of unspecified metal, intentional self-harm 

T56.93 Toxic effect of unspecified metal, assault

T56.94 Toxic effects of unspecified metal, undetermined 

T57.0 Toxic effect of arsenic and its compounds 

T57.0X Toxic effect of arsenic and its compounds 

T57.0X1 Toxic effect of arsenic and its compounds, accidental (unintentional)

T57.0X2 Toxic effect of arsenic and its compounds, intentional self-harm 

T57.0X3 Toxic effect of arsenic and its compounds, assault 

T57.0X4 Toxic effect of arsenic and its compounds, undetermined 

T57.2 Toxic effect of manganese and its compounds

T57.2X Toxic effect of manganese and its compounds 

T57.2X1 Toxic effect of manganese and its compounds, accidental (unintentional) 

T57.2X2 Toxic effect of manganese and its compounds, intentional self-harm 

T57.2X3 Toxic effect of manganese and its compounds, assault 

T57.2X4 Toxic effect of manganese and its compounds, undetermined

T58 Toxic effect of carbon monoxide 

T58.0 Toxic effect of carbon monoxide from motor vehicle exhaust 

T58.01 Toxic effect of carbon monoxide from motor vehicle exhaust, accidental (unintentional) T58.02 Toxic effect of carbon monoxide from motor vehicle exhaust, intentional selfharm 

T58.03 Toxic effect of carbon monoxide from motor vehicle exhaust, assault 

T58.04 Toxic effect of carbon monoxide from motor vehicle exhaust, undetermined 

T58.1 Toxic effect of carbon monoxide from utility gas 

T58.11 Toxic effect of carbon monoxide from utility gas, accidental (unintentional) 

T58.12 Toxic effect of carbon monoxide from utility gas, intentional self-harm 

T58.13 Toxic effect of carbon monoxide from utility gas, assault 

T58.14 Toxic effect of carbon monoxide from utility gas, undetermined 

T58.2 Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels 

T58.2X Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels

ICD-10 and Cardiology

Note: ICD-9-CM and ICD-10 are owned and copyrighted by the World Health Organization. The codes in this guide were obtained from the US Department of Health and Human Services, NCHS website. This guide does not contain ANY legal advice.

This guide shows what specific codes will change to when ICD-9-CM becomes ICD-10- CM

For the past thirty-one (31) years, we have learned and used ICD-9-CM when coding for our providers . As someone once said, just when we learned the answers, they changed the questions. Also, for years, there has been rumor that ICD-10 would be replacing ICD-9, and now this will soon be a reality

There is an old saying in coding, “If it isn’t documented, it doesn’t exist or it didn’t happen.” When ICD-10 becomes effective, it’s success is dependent on the provider’s documentation. If the documentation shows, “OM”, many of us know this means Otitis Media. Under ICD-9-CM, you have the following codes for OM:

382.9 - Unspecified otitis media, Otitis media: NOS, acute NOS, chronic NOS

ICD-10 will require more work on the provider to document the exact type of diagnosis found with the patient. ICD-10 opens more with the anatomical area affected and allows for coding of chronic modalities.

Under ICD-10-CM, you have the following codes for Otitis Media:

H66.9 Otitis media, unspecified

H66.90Otitis media, unspecified, unspecified ear

H66.91Otitis media, unspecified. right ear

H66.92Otitis media, unspecified, left ear

H66.93Otitis media, unspecified, bilateral

As you can see, under ICD-9-CM, you have one code you can select if the documentation is not specific. The patient may have been a child with ear pain in both ears, but all the doctor wrote is “OM” and nothing more. 

ICD-9-CM was very forgiving to the documentationally challenged provider and coder. Under ICD-10- CM, you have a possibility of five (5) codes and you do need more anatomical information to select the best possible code. 

Using a pure unspecified code such as H66.9 could cause your claim to be pended or placed under review, which could cause a significant revenue loss for the practice. One of my favorite doctor is a certified expert witness. He is called by lawyers for the doctor and malpractice insurance company. 

He reviews the documentation of the visit to make a recommend to proceed to trial or to settle out of court. Most of the depositions I’ve reviewed, this doctor’s recommendation, most of the time, is to settle because the documentation is not sufficient to fight a lawsuit. 

His recommendation to doctors, medical school students, interns and residents is “Document the visit as if you had to appear in court to defend your actions. “ I usually add, “Document the visit as if your paycheck and career is on the line.” 

I spend a lot of my time returning medical records for additional information because the documentation is insufficient to code the visit with 100% truth, accuracy and correctness. I code to protect the doctor, the patient, and MY paycheck. I only code what is documented. I never code a visit just to get paid. 

Again, if it isn’t documented, I don’t code it because it doesn’t exist. With 30 years of clinical medicine, I can say I know what should have been done during the visit, but I cant code based on that. Ive seen doctors in court that have said, “I did this procedure.” The lawyers say, “Show Me!”

Lets say you take your car to a mechanic to have your oil changed. You pick up your car and you are charged $3,000 for a new engine. You want to know why a $25 oil change cost $3,000. You are told the engine was replaced. 

You are entitled to see the old parts that were replaced. This happened to me one time and I asked to see the old part. I was told it was thrown away. I looked at the engine and couldn’t see the new part. All I saw was the old parts. I went to the dumpster and no part in the trash. 

The repair shop had no proof that they replaced the part. They dropped the charge for the replaced part. The medical record is proof of the old part, unless the doctor, doctors the medical record and if so, then something more serious is taking place. 

I just received a medical bill for care I received in 2007. There were charges I know didn’t take place. I demanded the medical record copy. The doctor refused. I did obtain the record copy which was maintained by the hospital. 

The doctor documented he saw me in my room on the ward. It was well documented to support a level 5 inpatient visit. The problem, I was in surgery having my heart operated on. It was impossible for the doctor to see me in my room while I was in surgery for 10 hours. 

The doctor is now being investigated for fraud because he trolled hospital wards, took medical records, documented extensive visits and waited for 4 years before sending a bill. It is very possible that this doctor will lose his medical license, not to mention patient lawsuits. 

I mention all of this to stress the importance of medical record documentation and to be 100% true, accurate, and correct with your documentation and coding.

Lets look at some of the most used codes in Public Medicine. Please understand that this guide does NOT contain all codes used. This guide does not take the place of coding or published coding manuals. These codes may change in October 2013. They are current as of the day this guide was prepared.

NUMERICAL ORDER BY ICD-9-CM

ICD-9-CM

250.00 Diabetes mellitus; w/o mention of complication or manifestation; type II, controlled

ICD-10-CM

E11.9 - Type 2 diabetes mellitus without complications

Note there are approximately 150 ICD-10 codes for Diabetes.

ICD-9-CM

272.4 Other and unspecified hyperlipidemia, Alpha-lipoproteinemia, Combined hyperlipidemia, Hyperlipidemia NOS, Hyperlipoproteinemia NOS

ICD-10-CM

E78.5 - Hyperlipidemia, unspecified

ICD-9-CM

285.9 - Anemia, unspecified, Anemia: NOS, essential, normocytic,not due to blood loss, profound, progressive, secondary, Oligocythemia

ICD-10-CM

D64.9 - Anemia, unspecified

ICD-9-CM

401.1 - Essential hypertension; benign

ICD-10-CM

I10 - Essential (primary) hypertension

ICD-9-CM

410.72 Acute myocardial infarction; subendocardial infarction; subsequent episode of care.