253 This article is a continuation of a series started in 2011 to help prepare AAP Pediatric Coding Newsletter™ subscribers for the transition to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) on October 1, 2014. This series has in- cluded articles introducing ICD-10-CM code structure, conventions, and guidelines and codes for specific conditions frequently managed by pediatricians. You can find past articles of this column at http://coding.aap.org by clicking on “Browse All Transitioning to 10” in the “Newsletter Features” box near the bottom of the page. With 6 months left to prepare for the transition, we hope that physicians and coders are beginning to have a familiarity with this code set. Many physicians and practices are now assessing their documentation to determine if current documentation is sufficient to support accurate ICD-10-CM code assignment. A first step in this process is to identify the elements of documentation necessary to support code assignment for a selected condition. For this article, we will focus on the documentation elements necessary to support assignment of codes for asthma. ICD-10-CM classifies asthma according to severity classification as described by the National Heart, Lung, and Blood Institute: intermittent, mild persistent, moderate per- sistent, and severe persistent (www.nhlbi.nih.gov/guidelines/asthma/04_sec3_comp.pdf). For each level of severity, codes may also indicate acute exacerbation or status asthmaticus. ICD-10-CM guidelines instruct that an acute exacerbation of asthma is a worsening or decompensation of the chronic condition. An acute exacerbation is not equivalent to an infection superimposed on asthma, but an infection could trigger an acute exacerbation, making it necessary to report a code for asthma with acute exacerbation and a code for the related infection. Tip The Table on page 5 shows the elements of documentation that will support selection of specific ICD-10-CM codes to report asthma. If documentation does not indicate the severity and status of asthma, code J45.909 must be reported indicating uncomplicated, unspecified asthma. Documentation of reactive airway disease without further specifica- tion would also result in assignment of code J45.909 because ICD-10-CM cross-references this term to asthma. Note that the Table is not used for exercise-induced asthma (J45.990) or cough variant asthma (J45.991). Coders assign codes for asthma with status asthmaticus only if this condition is specifically documented by the physician. Tip Appendix B-13 Documentation of Asthma (continued on page 254)
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