ICD-10 CM Question Interview Fresher Chapter 1
ICD 10 CM
Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99), U07.1, U09.9
Chapter 2: Neoplasms (C00-D49)
Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01 – F99)
Chapter 6: Diseases of the Nervous System (G00-G99)
Chapter 7: Diseases of the Eye and Adnexa (H00-H59)
Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95)
Chapter 9: Diseases of the Circulatory System (I00-I99)
Chapter 10: Diseases of the Respiratory System (J00-J99), U07.0
Chapter 11: Diseases of the Digestive System (K00-K95)
Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99)
Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
Chapter 14: Diseases of Genitourinary System (N00-N99)
Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)
Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96)
Chapter 17: Congenital malformations, deformations, and chromosomal abnormalities (Q00-QA1)
Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88
Chapter 20: External Causes of Morbidity (V00-Y99)
Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
Chapter 22: Codes for Special Purposes (U00-U85)
1. Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99), U07.1, U09.9
What are included in Chapter 1
The disease that is cause by any micro-organsim like virus ,bacteria,fungi etc and from parasite. Example -B20: HIV virus disease
A parasitic disease is an illness caused by a parasite that lives in or on the human body and obtains nutrients from the host. Example - Malaria disease cause by parasite protozoa- Plasmodium. B50.9 : Malaria
A and B series ICD codes are within this with U series also.
a. Human Immunodeficiency Virus (HIV) Infections
1) Code only confirmed cases
Code only confirmed cases of HIV infection/illness.
This is an exception to the hospital inpatient guideline Section II, H.
Yes — for inpatient hospital coding, there is a special rule for uncertain diagnoses.
Inpatient Rule
If the physician documents:
Suspected
Probable
Likely
Possible
Consistent with
Questionable
Still to be ruled out
Working diagnosis
at the time of discharge, code the condition as if it exists (confirmed).
In this context, “confirmation” does not require documentation of positive serology or culture for HIV; the provider’s diagnostic statement that the patient is HIV positive or has an HIV-related illness is sufficient.
Question: Is a positive HIV laboratory report required before assigning an HIV diagnosis code?
Answer: No. If the provider documents that the patient has HIV disease, is HIV positive, or has an HIV-related illness, the provider's diagnostic statement is sufficient. A positive serology or culture report is not required for ICD-10-CM coding.
2) Selection and sequencing of HIV codes
(a) HIV disease
Difference between HIV and AIDS ?
HIV is a virus that attacks the immune system
AIDS is the most advanced stage of HIV ininfection . In this, immune system becomes severely weak.
If the term “AIDS” or “HIV disease” is documented or if the patient is treated for any HIV-related illness or is described as having any condition(s) resulting from the patient’s HIV positive status; code B20, Human immunodeficiency virus [HIV], should be assigned.
AIDS : Code B20
HIV disease: Code B20
Even if the provider does not explicitly write "AIDS," if the patient is being treated for a condition caused by HIV, : Code B20.
HIV related disease : Code B20 first
Question : What will you code, if the in medical record, it is mention as
HIV-related Pneumocystis pneumonia : Code B20 and B59 Pneumocystosis
HIV-related candidiasis : Code B20,B37.9
b) Patient admitted for HIV-related condition
If a patient is admitted for an HIV-related condition, the principal diagnosis should be B20, Human immunodeficiency virus [HIV] disease followed by additional diagnosis codes for all reported HIV-related conditions.
Example : HIV-related candidiasis : Code B20,B37.9
An exception to this guideline is if the reason for admission is hemolytic-uremic syndrome associated with HIV disease.
Assign code D59.31, Infection-associated hemolytic-uremic syndrome, followed by code B20, Human immunodeficiency virus [HIV] disease.
(c) Patient with HIV disease admitted for unrelated condition
If a patient with HIV disease is admitted for an unrelated condition (such as a traumatic injury), the code for the unrelated condition (e.g., the nature of injury code) should be the principal diagnosis.
Code B20 would be reported as a secondary diagnosis. Codes for other documented conditions should also be reported as secondary diagnoses.
For example - The patient came for fracture of right femur and has HIV also, then code fracture as pdx and B20 as secondary , because fracture is not a related condition of HIV.
(d) Patient newly diagnosed with HIV disease
Whether the patient is newly diagnosed or has had previous admissions/encounters for HIV conditions is irrelevant to the sequencing decision.
When coding HIV disease (B20), it does not matter:
If this is the patient's first HIV diagnosis
If the patient has had HIV for 10 years
If the patient has been admitted many times before
These facts do not affect sequencing. B20 will always be first.
(e) Asymptomatic human immunodeficiency virus
When “HIV positive,” “HIV test positive,” or similar terminology is documented, and there is no documentation of symptoms or HIV-related illness, code Z21, Asymptomatic human immunodeficiency virus [HIV] infection status, should be assigned.
(f) Inconclusive HIV serology
Patients with documentation of inconclusive HIV serology, may be assigned code R75, Inconclusive laboratory evidence of human immunodeficiency virus [HIV].
Inconclusive HIV Serology
This means:
The HIV test result is unclear. The test does not definitely show that the patient is HIV-positive or HIV-negative.
The result is somewhere in between, so more testing is needed.
(g) Previously diagnosed HIV-related illness
Patients with documentation of a prior diagnosis of an HIV-related illness should be coded to B20. Once an HIV-related illness has developed, code B20 should always be assigned on every subsequent admission/encounter.
Patients previously diagnosed with any HIV illness (B20) should never be assigned to R75, Inconclusive laboratory evidence of human immunodeficiency virus [HIV] or Z21, Asymptomatic human immunodeficiency virus [HIV] infection status.
As for example : THe patient previous came for HIV related pneumonia 4 year ago and now in today serology report, the result in inconclusive, then how will you report.
Report with B20 always because previously he has confirm HIV and also hiv related disease.
(h) HIV Infection in Pregnancy, Childbirth and the Puerperium
When a patient presents during pregnancy, childbirth or the puerperium with documented symptomatic HIV disease or an HIV related illness, assign a code from subcategory O98.7, Human immunodeficiency [HIV] disease complicating pregnancy, childbirth and the puerperium, followed by code B20 and additional code(s) for any HIV-related illness(es).
Codes from Chapter 15 always take sequencing priority.
When a patient presents during pregnancy, childbirth or the puerperium with documented asymptomatic HIV infection status or is HIV-positive, assign a code from subcategory O98.7 followed by code Z21.
(i) Encounters for HIV testing
If a patient without signs or symptoms is tested for HIV, assign code Z11.4, Encounter for screening for human immunodeficiency virus [HIV]. Use additional codes for any associated high-risk behavior, if applicable.
Code Z11.4, Encounter for screening for human immunodeficiency virus [HIV], should not be assigned if HIV signs or symptoms are present.
Encounter for screening of HIV will be reported , if the patient solely come for only for HIV testing.
If a patient with signs or symptoms of HIV presents for HIV testing, code the signs and symptoms. An additional counseling code Z71.7, Human immunodeficiency virus [HIV] counseling, may be assigned if counseling is provided during the encounter for the test.
The patient is not coming for routine screening.
The patient has symptoms that could be related to HIV and is being tested because of those symptoms.
Example
Patient presents with: Persistent fever, Weight loss,Night sweats The physician orders an HIV test.
If the test is negative, Code Sign and Sympotom.
If test is positive, Code Z21
When a patient presents for follow up regarding their HIV test results and the test result is negative, assign code Z71.7, Human immunodeficiency virus [HIV] counseling.
(j) HIV disease or HIV positive status managed by antiretroviral medication
If a patient with documented HIV disease, HIV-related illness or AIDS is currently managed on antiretroviral medications, assign code B20, Human immunodeficiency virus [HIV] disease.
If a patient with documented HIV positive status is currently managed on antiretroviral medication, assign code Z21, Asymptomatic human immunodeficiency virus [HIV] infection status, in the absence of any additional documentation of HIV disease, HIV-related illness or AIDS.
Code Z79.899, Other long term (current) drug therapy, may be assigned as an additional code to identify the long-term (current) use of antiretroviral medications.
(k) Encounter for HIV Prophylaxis
Measures When a patient presents for administration of pre-exposure prophylaxis medication for HIV, assign code Z29.81, Encounter for HIV pre-exposure prophylaxis.
Pre-exposure prophylaxis (PrEP) is intended to prevent infection in people who are at risk for getting HIV through sex or injection drug use. Any risk factors for HIV should also be coded.
So, the patient will taken medication to avoid hiv infection in future.
Example : Patient on Pre-exposure prophylaxis and having High-risk heterosexual behavior. Then report : Z29.81- Encounter for HIV pre-exposure prophylaxis.
Z72.51 High risk heterosexual behavior
b. Infectious agents as the cause of diseases classified to other chapters
Certain infections are classified in chapters other than Chapter 1 and no organism is identified as part of the infection code. In these instances, it is necessary to use an additional code from Chapter 1 to identify the organism.
A code from category
B95, Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified to other chapters,
B96, Other bacterial agents as the cause of diseases classified to other chapters, or
B97, Viral agents as the cause of diseases classified to other chapters,
is to be used as an additional code to identify the organism.
An instructional note will be found at the infection code advising that an additional organism code is required.
Some infection codes tell you what infection the patient has, but do not tell you which organism caused it.
Example
N39.0 Urinary tract infection, site not specified. This tells us: UTI is present
But does NOT tell us:
❌ E. coli❌ Staphylococcus❌ Streptococcus
Suppose if physician say Urinay tract infection due to E.Coli
N39.0 Urinary tract infection
B96.20 Escherichia coli as cause of diseases classified elsewhere
B95-B97 codes are usually secondary codes.
They identify the organism.
They generally do not replace the infection code.
c. Infections resistant to antibiotics
Many bacterial infections are resistant to current antibiotics.
It is necessary to identify all infections documented as antibiotic resistant.
Assign a code from category Z16, Resistance to antimicrobial drugs, following the infection code only if the infection code does not identify drug resistance.
Some bacteria cannot be killed by certain antibiotics.
Examples:
MRSA resistant to Methicillin
VRE resistant to Vancomycin
E. coli resistant to multiple antibiotics
Examples:
Z16.11 Resistance to penicillins
Z16.24 Resistance to multiple antibiotics
(Exact code depends on the documented drug resistance.)
The infection is coded first.
The resistance code is secondary.
Example
Documentation:UTI due to E. coli resistant to ciprofloxacin.
Coding:
N39.0 UTI
B96.20 E. coli
Z16.xx Resistance to antimicrobial drug
If the infection code itself already tells you the organism is resistant, do not add Z16.
B95.62 already identifies Methicillin-resistant Staphylococcus aureus (MRSA).
Therefore:
❌ Do NOT add Z16.11
because resistance is already captured.
d. Sepsis, Severe Sepsis, and Septic Shock Infections resistant to antibiotics
Sepsis is a life-threatening condition that occurs when the body's response to an infection becomes uncontrolled and starts damaging its own organs.
Infection ( pnemonia )- Sepsis
Severe sepsis = Sepsis + Acute organ dysfunction caused by the sepsis.
A systemic infection is an infection that affects the entire body or spreads through the bloodstream, rather than staying in one specific location.
1) Coding of Sepsis and Severe Sepsis
(a) Sepsis
For a diagnosis of sepsis, assign the appropriate code for the underlying systemic infection.
When the physician documents sepsis, you code the specific sepsis code based on the organism or infection causing it.
Example : Sepsis due to E. coli - Assign A41.51 Sepsis due to Escherichia coli
Sepsis due to Streptococcus pneumoniae - Assign A40.3 Sepsis due to Streptococcus pneumoniae
If the type of infection or causal organism is not further specified, assign code A41.9, Sepsis, unspecified organism.
Patient admitted with Sepsis : A41.9 - Sepsis, unspecified organism
A code from subcategory R65.2, Severe sepsis, should not be assigned unless severe sepsis or an associated acute organ dysfunction is documented.
it is because Severe sepsis = Sepsis + Acute organ dysfunction caused by the sepsis.
(i) Negative or inconclusive blood cultures and sepsis
Negative or inconclusive blood cultures do not preclude or rule out a diagnosis of sepsis in patients with clinical evidence of the condition; however, the provider should be queried.
Code sepsis if the provider documents sepsis, even when blood cultures are negative.
❌ Do not assume sepsis is absent just because the blood culture is negative.
When to Query
Query the provider if:
Documentation is conflicting
Sepsis is mentioned inconsistently
The final diagnosis is unclear
(ii) Urosepsis
The term urosepsis is a nonspecific term. It is not to be considered synonymous with sepsis. It has no default code in the Alphabetic Index. Should a provider use this term, he/she must be queried for clarification.
Urosepsis is not a specific diagnosis.
Do not assume: Urosepsis = Sepsis
So, if you lead ICD for urosepsis , it will tell you to “code the condition”, so whatever condition is given you have to code or should query to physician.
As for example - Is urosepsis is Sepsis due to E. coli UTI
(iii) Sepsis with organ dysfunction
If a patient has sepsis and associated acute organ dysfunction or multiple organ dysfunction (MOD), follow the instructions for coding severe sepsis.
(iv)Acute organ dysfunction that is not clearly associated with the sepsis
If a patient has sepsis and an acute organ dysfunction, but the medical record documentation indicates that the acute organ dysfunction is related to a medical condition other than the sepsis, do not assign a code from subcategory R65.2, Severe sepsis.
An acute organ dysfunction must be associated with the sepsis in order to assign the severe sepsis code.
If the documentation is not clear as to whether an acute organ dysfunction is related to the sepsis or another medical condition, query the provider.
Example :
Patient admitted with E. coli sepsis.
Past history:Chronic kidney disease stage 5.
Assessment: Acute kidney injury due to dehydration. Sepsis due to E. coli.
Coding :
A41.51 Sepsis due to Escherichia coli
N17.9 Acute kidney failure, unspecified
E86.0 Dehydration
N18.5 Chronic kidney disease, stage 5
(b) Severe sepsis
The coding of severe sepsis requires a minimum of 2 codes: first a code for the underlying systemic infection, followed by a code from subcategory R65.2, Severe sepsis.
Example : Severe sepsis due to E. coli , report
A41.51 Sepsis due to E. coli
R65.20 Severe sepsis without septic shock
If the causal organism is not documented, assign code A41.9, Sepsis, unspecified organism, for the infection.
If the phsysican document : Severe sepsis
A41.9
R65.2
Additional code(s) for the associated acute organ dysfunction are also required. Due to the complex nature of severe sepsis, some cases may require querying the provider prior to assignment of the codes.
If the acute organ dysfunction is given then report.
1. Underlying systemic infection (A40-A41)
2. R65.2- Severe sepsis
3. Organ dysfunction code
Example : Severe sepsis due to UTI
Acute kidney injury
Coding
A41.9 (or specific sepsis code if organism known)
R65.20 Severe sepsis without septic shock
N17.9 Acute kidney injury
N39.0 Urinary tract infection
2) Septic shock
Septic shock is the most severe form of sepsis.
Septic shock generally refers to circulatory failure associated with severe sepsis, and therefore, it represents a type of acute organ dysfunction.
It occurs when an infection causes sepsis, and the patient's blood pressure drops dangerously low despite treatment, leading to inadequate blood flow to organs.
For cases of septic shock, the code for the systemic infection should be sequenced first, followed by code R65.21, Severe sepsis with septic shock or code T81.12, Postprocedural septic shock.
Any additional codes for the other acute organ dysfunctions should also be assigned.
As noted in the sequencing instructions in the Tabular List, the code for septic shock cannot be assigned as a principal diagnosis.
Note : Severe Sepsis = Sepsis + Acute Organ Dysfunction
Severe spesis with Septic shock = Sepsis + Organ Dysfunction+ Circulatory Failure (Shock)
Circulatory failure is the inability of the cardiovascular system to maintain adequate blood flow and oxygen delivery to tissues and organs.
Example :
Septic shock due to E. coli
Acute kidney failure
Acute respiratory failure
Code first organism (A41.51)
Septic Shock R65.21
Acute organ failures (N17.9 Acute kidney failure, J96.xx Acute respiratory failure )
Question: Can R65.21 be assigned if organ failure is not documented?
Answer:
Yes. When the provider documents septic shock, assign the underlying sepsis code followed by R65.21. Septic shock is by definition a form of severe sepsis. Additional organ dysfunction codes are reported only when the organ dysfunctions are documented.
3) Sequencing of severe sepsis
If severe sepsis is present on admission, and meets the definition of principal diagnosis, the underlying systemic infection should be assigned as principal diagnosis followed by the appropriate code from subcategory R65.2 as required by the sequencing rules in the Tabular List.
A code from subcategory R65.2 can never be assigned as a principal diagnosis. When severe sepsis develops during an encounter (it was not present on admission), the underlying systemic infection and the appropriate code from subcategory R65.2 should be assigned as secondary diagnoses.
Severe sepsis may be present on admission, but the diagnosis may not be confirmed until sometime after admission. If the documentation is not clear whether severe sepsis was present on admission, the provider should be queried.
4) Sepsis or severe sepsis with a localized infection
What is localized infection and systemic infection ?
A systemic infection affects the whole body and is usually found in ICD-10-CM categories A40-A41.Such as Sepsis.
A localized infection is confined to a specific body part or organ.
Examples
Pneumonia (lung)
UTI (urinary tract)
Cellulitis (skin)
If the reason for admission is sepsis or severe sepsis and a localized infection, such as pneumonia or cellulitis, a code(s) for the underlying systemic infection should be assigned first and the code for the localized infection should be assigned as a secondary diagnosis.
For Sepsis
Example : Sepsis due to cellulitis: Assign A41.xx Sepsis, L03.xx Cellulitis
For severe sepsis
If the patient has severe sepsis, a code from subcategory R65.2 should also be assigned as a secondary diagnosis.
Sequencing rule :
Sepsis first
R65.20 second
Organ dysfunction
Localized infection
Example : Severe sepsis due to pneumonia with Acute kidney failure .
A41.xx Sepsis
R65.20 Severe sepsis
N17.9 Acute kidney failure
J18.9 Pneumonia
If the patient is admitted with a localized infection, such as pneumonia, and sepsis/severe sepsis doesn’t develop. until after admission, the localized infection should be assigned first, followed by the appropriate sepsis/severe sepsis codes.
Admitted for pneumonia.
On hospital day 3, patient developed sepsis.
Then code : J18.9 Pneumonia, A41.xx Sepsis
5) Sepsis due to a postprocedural infection
(a) Documentation of causal relationship
As with all postprocedural complications, code assignment is based on the provider’s documentation of the relationship between the infection and the procedure.
(b) Sepsis due to a postprocedural infection
For sepsis following a postprocedural wound (surgical site) infection,
a code from
T81.41 to T81.43, Infection following a procedure OR
T81.49, Infection following a procedure, other surgical site,
or a code from O86.00 to O86.03, Infection of obstetric surgical wound OR
code O86.09, Infection of obstetric surgical wound, other surgical site, that identifies the site of the infection should be sequenced first, if known.
Any Postoprocedure - Surgical site infection - Sepsis ( Dont code sepsis as Pdx )
Assign an additional code for sepsis following a procedure (T81.44) or sepsis following an obstetrical procedure (O86.04). Use an additional code to identify the infectious agent.
Example 1
Patient underwent abdominal surgery laparoscopy cholecysteocmy.
Developed infected surgical wound deep.
Culture grew E. coli.
Physician diagnosed: Postprocedural wound infection with sepsis.
T81.42XA Infection following a procedure, deep incisional surgical site, initial encounter
T81.44X- Sepsis following a procedure
A41.51 Sepsis due to E. coli
Example 2 :
Patient underwent a Cesarean section (C-section).
Five days after delivery, the patient developed redness, swelling, and purulent drainage from the C-section incision site.
Blood cultures were positive for Staphylococcus aureus.
The physician diagnosed: Postpartum C-section wound infection with sepsis due to Staphylococcus aureus.
1. O86.00-O86.09 Obstetric surgical wound infection
2. O86.04 Sepsis following obstetrical procedure
3. A41.01/A41.02 Organism-specific sepsis
If the patient has severe sepsis, the appropriate code from subcategory R65.2 should also be assigned with the additional code(s) for any acute organ dysfunction.
Infusion is the administration of fluids, medications, blood products, or nutrients slowly into a vein over a period of time.
Transfusion is the transfer of blood or blood components from a donor to a patient.
Therapeutic injection is the administration of a medication by injection for treatment purposes.
Immunization is the process of protecting a person against a disease by administering a vaccine that helps the body's immune system develop immunity.
For infections following infusion, transfusion, therapeutic injection, or immunization, a code from subcategory T80.2, Infections following infusion, transfusion, and therapeutic injection,
or
code T88.0-, Infection following immunization, should be coded first,
followed by the code for the specific infection.
Example 1 :
Patient received IV infusion.
Developed bloodstream infection due to contaminated IV line.
Physician diagnosed: Infection following infusion due to Staphylococcus aureus.
Coding
T80.2XXA Infection following infusion
A41.01 Sepsis due to MSSA
Example 2 :
Patient developed infection at vaccination site.
Diagnosis: Infection following immunization.
T88.0XXA Infection following immunization
Specific infection code
If the patient has severe sepsis, the appropriate code from subcategory R65.2 should also be assigned, with the additional codes(s) for any acute organ dysfunction.
Patient received a blood transfusion.
Developed infection.
Severe sepsis with acute kidney injury.
Coding Order
T80.2XXA Infection following transfusion
A41.9 Sepsis, unspecified organism
R65.20 Severe sepsis without septic shock
N17.9 Acute kidney failure
(c) Postprocedural infection and postprocedural septic shock
If a postprocedural infection has resulted in postprocedural septic shock, assign the codes indicated above for sepsis due to a postprocedural infection, followed by code T81.12-, Postprocedural septic shock. Do not assign code R65.21, Severe sepsis with septic shock. Additional code(s) should be assigned for any acute organ dysfunction.
Example : Patient underwent laparoscopic colectomy.
Five days later, the patient developed an infected surgical wound.
Wound culture grew E. coli.
The infection progressed to sepsis and postprocedural septic shock.
The patient also developed acute kidney failure.
Final Diagnosis:
Postprocedural wound infection with E. coli sepsis, postprocedural septic shock, and acute kidney failure.
T81.41XA Infection following procedure
T81.44XA Sepsis following procedure
A41.51 Sepsis due to E. coli
T81.12XA Postprocedural septic shock
N17.9 Acute kidney failure
6) Sepsis and severe sepsis associated with a noninfectious process (condition)
In some cases, a noninfectious process (condition) such as trauma, may lead to an infection which can result in sepsis or severe sepsis. If sepsis or severe sepsis is documented as associated with a noninfectious condition, such as a burn or serious injury, and this condition meets the definition for principal diagnosis, the code for the noninfectious condition should be sequenced first, followed by the code for the resulting infection.
Example 1
Patient admitted with third-degree burns to the trunk.
The burn wounds became infected with Pseudomonas.
The patient developed sepsis due to the wound infection.
T21.xxxA Third-degree burn of trunk
A41.52 Sepsis due to Pseudomonas
Burn wound infection code (if documented)
Example 2
Patient admitted with crush injury of the leg.
Wound became infected with E. coli.
Patient developed severe sepsis with acute kidney injury.
S87.xxxA Crush injury
A41.51 Sepsis due to E. coli
R65.20 Severe sepsis
N17.9 Acute kidney failure
If severe sepsis is present, a code from subcategory R65.2 should also be assigned with any associated organ dysfunction(s) codes. It is not necessary to assign a code from subcategory R65.1, Systemic inflammatory response syndrome (SIRS) of non-infectious origin, for these cases.
If the infection meets the definition of principal diagnosis, it should be sequenced before the non-infectious condition. When both the associated non-infectious condition and the infection meet the definition of principal diagnosis, either may be assigned as principal diagnosis.
Patient sustained a small second-degree burn on the arm 2 weeks ago.
Now presents with sepsis due to infected burn wound.
Reason for admission: Treatment of sepsis.
A41.9 Sepsis, unspecified organism ← Principal Diagnosis
T22.20XA Burn of second degree of unspecified upper limb
T31.0 Burns involving less than 10% of body surface
Only one code from category R65, Symptoms and signs specifically associated with systemic inflammation and infection, should be assigned. Therefore, when a non-infectious condition leads to an infection resulting in severe sepsis, assign the appropriate code from subcategory R65.2, Severe sepsis. Do not additionally assign a code from subcategory R65.1, Systemic inflammatory response syndrome (SIRS) of noninfectious origin. See Section I.C.18. SIRS due to non-infectious process
7) Sepsis and septic shock complicating abortion, pregnancy, childbirth, and the puerperium See Section I.C.15. Sepsis and septic shock complicating abortion, pregnancy, childbirth and the puerperium
8) Newborn sepsis See Section I.C.16. f. Bacterial sepsis of Newborn
9) Hemolytic-uremic syndrome associated with sepsis
If the reason for admission is hemolytic-uremic syndrome that is associated with sepsis, assign code D59.31, Infection-associated hemolytic-uremic syndrome, as the principal diagnosis. Codes for the underlying systemic infection and any other conditions (such as severe sepsis) should be assigned as secondary diagnoses.
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