2024 coding

guidelines Expert
included

ICD-10-CM Expert
for Home Health

E
and Hospice
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The complete official code set
Codes valid from October 1, 2023
through September 30, 2024
M
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2024
optumcoding.com
Contents
How to Use ICD-10-CM Expert for Home Health and Chapter 7. Diseases of the Eye and Adnexa (H00-H59) ............607
Hospice 2024 ...................................................................... iii Chapter 8. Diseases of the Ear and Mastoid Process
Introduction ................................................................................................. iii (H60-H95) ........................................................................645
What’s New for 2024 .................................................................................. iii Chapter 9. Diseases of the Circulatory System (I00-I99) ...........657
Conversion Table ........................................................................................ iii
Chapter 10. Diseases of the Respiratory System (J00-J99) .........701
10 Steps to Correct Coding ....................................................................... iii
Official ICD-10-CM Guidelines for Coding and Reporting ................. iii Chapter 11. Diseases of the Digestive System (K00-K95) ...........717
Indexes .......................................................................................................... iii Chapter 12. Diseases of the Skin and Subcutaneous Tissue
Index to Diseases and Injuries .......................................................... iii (L00-L99) ..........................................................................743
Neoplasm Table................................................................................... iii Chapter 13. Diseases of the Musculoskeletal System and
Table of Drugs and Chemicals ......................................................... iv Connective Tissue (M00-M99) ....................................767
External Causes Index ........................................................................ iv
Chapter 14. Diseases of the Genitourinary System
Index Notations ................................................................................... iv (N00-N99) ........................................................................857
Tabular List of Diseases .............................................................................. v
Code and Code Descriptions ............................................................. v Chapter 15. Pregnancy, Childbirth and the Puerperium
(O00-O9A) ........................................................................879
Tabular Notations ................................................................................ v
Official Notations .................................................................................. v Chapter 16. Certain Conditions Originating in the Perinatal
Optum Notations ................................................................................ vi Period (P00-P96) ............................................................919

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Icons ....................................................................................................... vi Chapter 17. Congenital Malformations, Deformations and
Color Bars .............................................................................................vii Chromosomal Abnormalities (Q00-Q99) .................933
Chapter-Level Notations ..........................................................................vii Chapter 18. Symptoms, Signs and Abnormal Clinical and
Appendixes .................................................................................................vii Laboratory Findings (R00-R99) ...................................953

What’s New for 2024 .......................................................... ix

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Illustrations................................................................................................. viii

Official Updates ........................................................................................... ix

Proprietary Updates ................................................................................... xi

Conversion Table of ICD-10-CM Codes ............................. xiii

Chapter 19. Injury, Poisoning and Certain Other Consequences
of External Causes (S00-T88) .......................................975
Chapter 20. External Causes of Morbidity (V00-Y99)................. 1181
Chapter 21. Factors Influencing Health Status and Contact
With Health Services (Z00-Z99) ............................... 1249
Chapter 22. Codes for Special Purposes (U00-U85) ................... 1289

Appendixes .....................................................Appendixes–1
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10 Steps to Correct Coding .............................................. xvii Appendix A: Valid 3-character ICD-10-CM Codes.......Appendixes–1
Appendix B: Pharmacology List 2023............................Appendixes–3
Appendix C: Z Codes for Long-Term Drug Use with
ICD-10-CM Official Guidelines for Associated Drugs ..................................... Appendixes–20
Coding and Reporting ......................... Coding Guidelines–1 Appendix D: Qualifications for Medicare Coverage of
Home Health Services............................. Appendixes–23
ICD-10-CM Index to Diseases and Injuries .......................... 1 Appendix E: Overview of the Patient-Driven Groupings
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Model (PDGM) .......................................... Appendixes–29

Appendix F: OASIS Diagnosis Guidance .................... Appendixes–32
ICD-10-CM Neoplasm Table ............................................. 342
Appendix G: Patient-Driven Groupings Model (PDGM)
Comorbid Conditions ............................. Appendixes–39
ICD-10-CM Table of Drugs and Chemicals ....................... 361 Appendix H: Patient-Driven Groupings Model (PDGM)
Return-to-Provider Code List................ Appendixes–43
Appendix I: Hospice Criteria for Medicare Coverage of
ICD-10-CM Index to External Causes................................ 411
Noncancer Hospice Care........................ Appendixes–51
Appendix J: Hospice Diagnosis and Quality Reporting
ICD-10-CM Tabular List of Diseases and Injuries ............ 447 Guidance.................................................... Appendixes–58
Chapter 1. Certain Infectious and Parasitic Diseases Appendix K: Coding Issues for Long-Term
(A00-B99) ......................................................................... 447 Care (LTC)................................................... Appendixes–61
Chapter 2. Neoplasms (C00-D49) .................................................. 473
Illustrations.................................................... Illustrations–1
Chapter 3. Diseases of the Blood and Blood-forming Chapter 3. Diseases of the Blood and Blood-forming Organs
Organs and Certain Disorders Involving the and Certain Disorders Involving the Immune
Immune Mechanism (D50-D89) ................................ 513 Mechanism (D50–D89) ..............................Illustrations–1
Chapter 4. Endocrine, Nutritional and Metabolic Diseases Red Blood Cells ........................................ Illustrations–1
(E00-E89) ......................................................................... 527 White Blood Cell ...................................... Illustrations–1
Chapter 5. Mental, Behavioral, and Neurodevelopmental Platelet ...................................................... Illustrations–2
Disorders (F01-F99) ....................................................... 551 Coagulation .............................................. Illustrations–2
Spleen Anatomical Location and
Chapter 6. Diseases of the Nervous System (G00-G99) ............ 583 External Structures ............................. Illustrations–3
Spleen Interior Structures ..................... Illustrations–3

ICD-10-CM 2024 i
Contents
Chapter 4. Endocrine, Nutritional and Metabolic Chapter 10. Diseases of the Respiratory
Diseases (E00–E89) .................................... Illustrations–4 System (J00–J99) ...................................... Illustrations–26
Endocrine System ................................... Illustrations–4 Respiratory System ............................... Illustrations–26
Thyroid ...................................................... Illustrations–5 Upper Respiratory System .................. Illustrations–27
Thyroid and Parathyroid Glands ......... Illustrations–5 Lower Respiratory System .................. Illustrations–27
Pancreas ................................................... Illustrations–6 Paranasal Sinuses ................................. Illustrations–27
Anatomy of the Adrenal Gland ........... Illustrations–6 Lung Segments ..................................... Illustrations–28
Structure of an Ovary ............................ Illustrations–7 Alveoli ...................................................... Illustrations–28
Testis and Associated Structures ........ Illustrations–7 Chapter 11. Diseases of the Digestive System
Thymus ..................................................... Illustrations–8 (K00–K95) ................................................... Illustrations–29
Chapter 6. Diseases of the Nervous System Digestive System .................................. Illustrations–29
(G00–G99) .................................................... Illustrations–9 Omentum and Mesentery ................. Illustrations–30
Brain ........................................................... Illustrations–9 Peritoneum and Retroperitoneum ... Illustrations–30
Cranial Nerves ......................................... Illustrations–9 Chapter 12. Diseases of the Skin and Subcutaneous
Peripheral Nervous System ................ Illustrations–10 Tissue (L00–L99) ....................................... Illustrations–31
Spinal Cord and Spinal Nerves .......... Illustrations–11 Nail Anatomy ......................................... Illustrations–31
Nerve Cell ............................................... Illustrations–12 Skin and Subcutaneous Tissue .......... Illustrations–31
Trigeminal and Facial Nerve Chapter 13. Diseases of the Musculoskeletal System
Branches ............................................... Illustrations–12 and Connective Tissue (M00–M99) ...... Illustrations–32
Chapter 7. Diseases of the Eye and Adnexa Bones and Joints ................................... Illustrations–32
(H00–H59) .................................................. Illustrations–13 Shoulder Anterior View ....................... Illustrations–33
Eye ............................................................ Illustrations–13 Shoulder Posterior View ..................... Illustrations–33

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Posterior Pole of Globe/Flow of Elbow Anterior View ............................ Illustrations–33
Aqueous Humor ............................... Illustrations–13 Elbow Posterior View ........................... Illustrations–33
Lacrimal System .................................... Illustrations–14 Hand ......................................................... Illustrations–33
Eye Musculature ................................... Illustrations–14 Hip Anterior View ................................. Illustrations–34
Eyelid Structures ................................... Illustrations–14 Hip Posterior View ................................ Illustrations–34
Chapter 8. Diseases of the Ear and Mastoid

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Process (H60–H95) ................................... Illustrations–15
Ear Anatomy .......................................... Illustrations–15
Chapter 9. Diseases of the Circulatory
System (I00–I99) ....................................... Illustrations–16
Anatomy of the Heart .......................... Illustrations–16
Heart Cross Section .............................. Illustrations–16
Heart Valves ........................................... Illustrations–17
Heart Conduction System .................. Illustrations–17
Coronary Arteries ................................. Illustrations–18
Knee Anterior View .............................. Illustrations–34
Knee Posterior View ............................. Illustrations–34
Foot .......................................................... Illustrations–34
Muscles..................................................... Illustrations–35
Chapter 14. Diseases of the Genitourinary
System (N00–N99) .................................... Illustrations–36
Urinary System ...................................... Illustrations–36
Male Genitourinary System ................ Illustrations–37
Female Internal Genitalia ................... Illustrations–37
Female Genitourinary Tract Lateral
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Arteries .................................................... Illustrations–19 View ...................................................... Illustrations–37
Veins ........................................................ Illustrations–20 Chapter 15. Pregnancy, Childbirth and the
Internal Carotid and Vertebral Puerperium (O00–O9A) ..........................Illustrations–38
Arteries and Branches ..................... Illustrations–21 Term Pregnancy – Single
External Carotid Artery and Gestation ............................................. Illustrations–38
Branches ............................................. Illustrations–21 Twin Gestation–Dichorionic–
Branches of Abdominal Aorta ........... Illustrations–22 Diamniotic (DI-DI) ............................. Illustrations–38
Portal Venous Circulation ................... Illustrations–22
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Twin Gestation–Monochorionic–
Lymphatic System ................................ Illustrations–23 Diamniotic (MO-DI) .......................... Illustrations–39
Axillary Lymph Nodes ......................... Illustrations–24 Twin Gestation–Monochorionic–
Lymphatic System of Head Monoamniotic (MO-MO) ................. Illustrations–39
and Neck ............................................. Illustrations–24 Chapter 19. Injury, Poisoning and Certain Other
Lymphatic Capillaries .......................... Illustrations–25 Consequences of External Causes
Lymphatic Drainage ............................ Illustrations–25 (S00-T88) ......................................................Illustrations–40
Types of Fractures ................................. Illustrations–40
Salter-Harris Fracture Types ............... Illustrations–40

ii ICD-10-CM 2024
 How to Use ICD-10-CM Expert

How to Use ICD-10-CM Expert for Home Health and Hospice 2023
for Home Health and Hospice 2024
Introduction What’s New for 2024
ICD-10-CM Expert for Home Health and Hospice: The Complete Official Code This section provides a high-level overview of the code changes made for
Set is your definitive coding resource, combining the work of the National fiscal 2023. The list of codes provided identify new, revised, and deleted
Center for Health Statistics (NCHS), Centers for Medicare and Medicaid codes. Asterisked codes identify prior midyear changes that were made to
Services (CMS), American Hospital Association (AHA), and Optum experts the classification, effective April 1, 2022. All changes are based on official
to provide the information you need for coding accuracy. addendum, provided by the National Center for Health Statistics (NCHS),
the agency charged with maintaining and updating ICD-10-CM. NCHS is
The International Classification of Diseases, 10th Revision, Clinical
part of the Centers for Disease Control and Prevention (CDC).
Modification (ICD-10-CM), is an adaptation of ICD-10, copyrighted by the
World Health Organization (WHO). The development and maintenance of
this clinical modification (CM) is the responsibility of the NCHS as Conversion Table
authorized by WHO. Any new concepts added to ICD-10-CM are based on The conversion table was developed by National Center for Healthcare
an established update process through the collaboration of WHO’s Statistics (NCHS) to help facilitate data retrieval as new codes are added to
Update and Revision Committee and the ICD-10-CM Coordination and the ICD-10-CM classification. This table provides a crosswalk from each
Maintenance Committee. fiscal 2023 new code to the equivalent code(s) assigned, prior to October
In addition to the ICD-10-CM classification, other official government 1, 2022, for that diagnosis or condition. Asterisked codes identify prior

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source information has been included in this manual. Depending on the midyear additions, effective April 1, 2022. For the full conversion table,
source, updates to information may be annual or quarterly. This manual refer to the Conversion Table zip file at
provides the most current information that was available at the time of https://www.cms.gov/medicare/icd-10/2023-icd-10-cm.
publication. For updates to the source documents that may have occurred
after this manual was published, please refer to the following:

Clinical Modification (ICD-10-CM)

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• NCHS, International Classification of Diseases, Tenth Revision,

https://www.cms.gov/medicare/icd-10/2023-icd-10-cm
• CMS Integrated Outpatient Code Editor (IOCE), version 23.2
10 Steps to Correct Coding
This step-by-step tutorial walks the coder through the process of finding
the correct code — from locating the code in the official indexes to
verifying the code in the tabular section — while following applicable
conventions, guidelines, and instructional notes. Specific examples are
provided with detailed explanations of each coding step along with
https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQ advice for proper sequencing.
trReleaseSpecs.html
• CMS Home Health Patient-Driven Groupings Model (PDGM) Official ICD-10-CM Guidelines for Coding
M
https://www.cms.gov/Medicare/Medicare-Fee-for-Service- and Reporting
Payment/HomeHealthPPS/HH-PDGM.html This section provides the full official conventions and guidelines
• CMS Hospice Quality Reporting Requirements regulating the appropriate assignment and reporting of ICD-10-CM codes.
These conventions and guidelines are published by the U.S. Department
https://www.cms.gov/Medicare/Medicare-Fee-for-Service- of Health and Human Services (DHHS) and approved by the cooperating
Payment/Hospice/Hospice-Regulations-and-Notices parties (American Health Information Management Association [AHIMA],
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• AHA Coding Clinics National Center for Health Statistics [NCHS], Centers for Disease Control
and Prevention [CDC], and the American Hospital Association [AHA]).
https://www.codingclinicadvisor.com/
The official NCHS ICD-10-CM classification includes three main sections:
the guidelines, the indexes, and the tabular list, all of which make up the
Indexes
bulk of this coding manual. To complement the classification, Optum’s
coding experts have incorporated Medicare-related coding edits and Index to Diseases and Injuries
proprietary features, such as supplementary notations, coding tools, and The Index to Diseases and Injuries is arranged in alphabetic order by terms
appendixes, into a comprehensive and easy-to-use reference. This specific to a disease, condition, illness, injury, eponym, or abbreviation as
publication is organized as follows: well as terms that describe circumstances other than a disease or injury
that may require attention from a health care professional.

Neoplasm Table
The Neoplasm Table is arranged in alphabetic order by anatomical site.
Codes are then listed in individual columns based upon the histological
behavior (malignant, in situ, benign, uncertain, or unspecified) of the
neoplasm.

ICD-10-CM 2024 iii

ICD-10-CM 2024 How to Use ICD-10-CM Expert for Home Health and Hospice 2024

How to Use ICD-10-CM Expert for Home Health and Hospice 2024
Sex Edits Color Bars
Codes intended for a specific sex based on CMS IOCE designations, v22.2.
Manifestation Code
: Male diagnosis only Codes defined as manifestation codes appear in italic type, with a
blue color bar over the code description. A manifestation cannot be
Q98.0 Klinefelter syndrome karyotype 47, XXY :
reported as a first-listed code; it is sequenced as a secondary
diagnosis with the underlying disease code listed first.
; Female diagnosis only
G32.89 Other specified degenerative disorders of nervous system in
N35.12 Postinfective urethral stricture, not elsewhere diseases classified elsewhere W
classified, female ; Degenerative encephalopathy in diseases classified elsewhere
V Comorbidity Low
Unspecified Diagnosis
This symbol identifies secondary diagnosis codes that are Codes that appear with a gray color bar over the alphanumeric code
considered a low comorbidity relative to the primary diagnosis. identify unspecified diagnoses. These codes should be used in
When at least one comorbidity-low diagnosis is reported on a home limited circumstances, when neither the diagnostic statement nor
health claim, the period of care receives a low comorbidity payment the documentation provides enough information to assign a more
adjustment. For a comprehensive list of all comorbidity-low specific diagnosis code. The abbreviation NOS, “not otherwise
diagnosis codes, refer to appendix G, “Patient-Driven Groupings specified,” in the tabular list may be interpreted as “unspecified.”
Model (PDGM) Comorbid Conditions,” at the back of this book.
G03.9 Meningitis, unspecified W
C00.8 Malignant neoplasm of overlapping sites of lip V Arachnoiditis (spinal) NOS

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U Comorbidity High
This symbol identifies secondary diagnosis codes that are Chapter-Level Notations
considered a high comorbidity relative to the primary diagnosis.
When at least two comorbidity-high diagnoses are reported on a Chapter-specific Guidelines with Coding Examples
home health claim, the period of care receives a high comorbidity Each chapter begins with the Official Guidelines for Coding and Reporting

F33.0
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payment adjustment. For a comprehensive list of all comorbidity-
high diagnosis codes, refer to appendix G, “Patient-Driven
Groupings Model (PDGM) Comorbid Conditions,” at the back of this
book.

Major depressive disorder, recurrent, mild

W Return to Provider
This symbol identifies diagnosis codes that are considered to be
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specific to that chapter, where provided. Coding examples specific to
outpatient care settings have been provided to illustrate the coding
and/or sequencing guidance in these guidelines.
Muscle and Tendon Table
ICD-10-CM categorizes certain muscles and tendons in the upper and
lower extremities by their action (e.g., extension or flexion) as well as their
anatomical location. The Muscle/Tendon table is provided at the
beginning of chapter 13 and chapter 19 to help users when code selection
depends on the action of the muscle and/or tendon.
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vague, unspecified, or, based on the ICD-10-CM coding guidelines
and conventions, inappropriate for reporting as the principal Note: This table is not all-inclusive, and proper code assignment should
diagnosis. If one of these diagnosis codes is reported as a principal be based on the provider’s documentation.
diagnosis on the home health claim, the claim will be returned to
the home health agency for a more definitive diagnosis code. For a
comprehensive list of all return-to-provider codes, refer to appendix Appendixes
H, “Patient-Driven Groupings Model (PDGM) Return-to-Provider The additional resources described below have been included as
Code List,” at the back of this book. appendixes for this book. These resources further instruct the professional
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coder on the appropriate application of the ICD-10-CM code set.

A18.10 Tuberculosis of genitourinary system, unspecified W
Appendix A: Valid 3-character ICD-10-CM Codes
X Noncancer Diagnosis The user may consult this table to confirm that no further specificity, such
This symbol indicates a noncancer diagnosis that may satisfy the as the use of 4th, 5th, 6th or 7th characters or placeholders (X), is
medical necessity criteria for Medicare coverage of hospice care. necessary. All ICD-10-CM codes that are valid at the three-character level
The diagnosis alone does not support medical necessity but are listed.
represents one of the many factors that establish medical necessity. Appendix B: Pharmacology List 2023
For more detailed explanation of the noncancer diagnosis policies This reference is a comprehensive but not all-inclusive list of
for hospice care, please refer to appendix I, “Hospice Criteria for pharmacological agents used to treat acute and/or chronic conditions.
Medicare Coverage on Noncancer Hospice Care,” at the back of this Drugs are listed in alphabetical order by their brand and/or generic names
book. along with their drug action and indications for which they may
commonly be prescribed. Some drugs have also been mapped to their
I51.5 Myocardial degeneration X
Fatty degeneration of heart or myocardium appropriate Z code for long-term drug use.
Myocardial disease
Senile degeneration of heart or myocardium Appendix C: Z Codes for Long-Term Drug Use with Associated Drugs
This resource correlates Z codes that are used to identify current long-
term drug use with a list of drugs that are typically categorized to that
class of drug.
Note: These tables are not all-inclusive but list some of the more
commonly used drugs.

ICD-10-CM 2024 vii

Conversion Table of ICD-10-CM Codes

Conversion Table of ICD-10-CM Codes

The fiscal 2023 (October 1, 2022–September 30, 2023) Conversion Table for new ICD-10-CM codes is provided to assist users in data retrieval. For
each new code the table shows its previously assigned code equivalent. Asterisks identify new codes added to the classification April 1, 2022.

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Previous

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Code(s)

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Code(s)

Code(s)
Code(s)

Code

Code

Code

Code

Code
Code

B37.31 B37.3 F01.C3 F01.51 F13.91 F13.90 I71.012 I71.01 M93.061 M93.011 N80.322 N80.3
B37.32 B37.3 F01.C4 F01.51 F14.91 F14.90 I71.019 I71.01 M93.062 M93.012 N80.329 N80.3
D59.30 D59.3 F02.811 F02.81 F15.91 F15.90 I71.10 I71.1 M93.063 M93.013 N80.331 N80.3
D59.31 D59.3 F02.818 F02.81 F16.91 F16.90 I71.11 I71.1 M93.064 M93.011 & N80.332 N80.3
F02.82 F02.81 F18.91 F18.90 I71.12 I71.1 M93.012 N80.333 N80.3
D59.32 D59.3
F02.83 F02.81 F19.91 F19.90 I71.13 I71.1 M93.071 M93.031 N80.339 N80.3
D59.39 D59.3
F02.84 F02.81 F43.81 F43.8 I71.20 I71.2 M93.072 M93.032 N80.341 N80.3
D68.00 D68.0
F02.A0 F02.80 F43.89 F43.8 I71.21 I71.2 M93.073 M93.033 N80.342 N80.3
D68.01 D68.0
F02.A11 F02.81 G71.031 G71.09 I71.22 I71.2 M93.074 M93.031 & N80.343 N80.3
D68.020 D68.0 M93.032
D68.021 D68.0 F02.A18 F02.81 G71.032 G71.09 I71.23 I71.2 N80.349 N80.3
M96.A1 M96.89 &
D68.022 D68.0 F02.A2 F02.81 G71.033 G71.09 I71.30 I71.3 Y84.8 N80.351 N80.3

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D68.023 D68.0 F02.A3 F02.81 G71.0340 G71.09 I71.31 I71.3 M96.A2 M96.89 & N80.352 N80.3
D68.029 D68.0 F02.A4 F02.81 G71.0341 G71.09 I71.32 I71.3 Y84.8 N80.353 N80.3
D68.03 D68.0 F02.B0 F02.80 G71.0342 G71.09 I71.33 I71.3 M96.A3 M96.89 & N80.359 N80.3
F02.B11 F02.81 G71.0349 G71.09 I71.40 I71.4 Y84.8 N80.361 N80.3
D68.04 D68.0
F02.B18 F02.81 G71.035 G71.09 I71.41 I71.4 M96.A4 M96.89 & N80.362 N80.3
D68.09
D75.821
D75.822
D75.828
D75.829
D75.84
D81.82
E34.30
E34.31
D68.0
D75.82
D75.82
D75.82
D75.82
D75.89
D81.89
E34.3
E34.3
F02.B2
F02.B3
F02.B4
F02.C0
F02.C11
F02.C18
F02.C2
F02.C3
F02.81
F02.81
F02.81
F02.80
F02.81
F02.81
F02.81
F02.81
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G71.038
G71.039
G90.A
G93.31
G93.32

G93.39
I20.2
G71.09
G71.09
I49.8
G93.3
G93.3;
R53.82
G93.3
I20.0-I20.1;
I20.8
I71.42
I71.43
I71.50
I71.51
I71.52
I71.60
I71.61
I71.62
I71.4
I71.4
I71.5
I71.5
I71.5
I71.6
I71.6
I71.6
M96.A9

N14.11
N14.19
N76.82
N80.00
N80.01
N80.02
Y84.8
M96.89 &
Y84.8
N14.1
N14.1
N76.89
N80.0
N80.0
N80.0
N80.363
N80.369
N80.371
N80.372
N80.373
N80.379
N80.381
N80.382
N80.3
N80.3
N80.3
N80.3
N80.3
N80.3
N80.3
N80.3
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E34.321 E34.3 F02.C4 F02.81 I77.82 I77.89 N80.03 N80.0 N80.383 N80.3
I25.112 I25.110-
E34.322 E34.3 F03.911 F03.91 I25.111; J95.87 J95.89 N80.101 N80.1 N80.389 N80.3
E34.328 E34.3 F03.918 F03.91 I25.118 K76.82 K72.90- N80.102 N80.1 N80.3A1 N80.3
F03.92 F03.91 I25.702 I25.700- K72.91 N80.3A2 N80.3
E34.329 E34.3 N80.103 N80.1
F03.93 F03.91 I25.701; M51.A0 M51.86 N80.3A3 N80.3
E34.39 E34.3 I25.708 N80.109 N80.1
F03.94 F03.91 M51.A1 M51.86 N80.3A9 N80.3
E87.20 E87.2 I25.712 I25.710- N80.111 N80.1
F03.A0 F03.90 M51.A2 M51.86 N80.3B1 N80.3
E87.21 E87.2 I25.711; N80.112 N80.1
M51.A3 M51.87
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E87.22 E87.2 F03.A11 F03.91 I25.718 N80.113 N80.1 N80.3B2 N80.3

F03.A18 F03.91 I25.722 I25.720- M51.A4 M51.87 N80.3B3 N80.3
E87.29 E87.2 N80.119 N80.1
F03.A2 F03.91 I25.721; M51.A5 M51.87 N80.3B9 N80.3
F01.511 F01.51 I25.728 N80.121 N80.1
F03.A3 F03.91 M62.5A0 M62.58 N80.3C1 N80.3
F01.518 F01.51 I25.732 I25.730- N80.122 N80.1
F03.A4 F03.91 M62.5A1 M62.58 N80.3C2 N80.3
F01.52 F01.51 I25.731; N80.123 N80.1
F03.B0 F03.90 I25.738 M62.5A2 M62.58 N80.3C3 N80.3
F01.53 F01.51 N80.129 N80.1
F03.B11 F03.91 I25.752 I25.750- M62.5A9 M62.58 N80.3C9 N80.3
F01.54 F01.51 N80.201 N80.2
F03.B18 F03.91 I25.751; M93.004 M93.001 & N80.391 N80.3
F01.A0 F01.50 I25.758 M93.002 N80.202 N80.2
F01.A11 F01.51 F03.B2 F03.91 N80.203 N80.2 N80.392 N80.3
I25.762 I25.760- M93.014 M93.011 &
F01.A18 F01.51 F03.B3 F03.91 I25.761; M93.012 N80.209 N80.2 N80.399 N80.3
F01.A2 F01.51 F03.B4 F03.91 I25.768 M93.024 M93.021 & N80.211 N80.2 N80.40 N80.3
F01.A3 F01.51 F03.C0 F03.90 I25.792 I25.790- M93.022 N80.212 N80.2 N80.41 N80.4
F03.C11 F03.91 I25.791; M93.034 M93.031 & N80.42 N80.4
F01.A4 F01.51 I25.798 N80.213 N80.2
F03.C18 F03.91 M93.032 N80.50 N80.5
F01.B0 F01.50 I31.31 I31.3 N80.219 N80.2
F03.C2 F03.91 M93.041 M93.011 N80.511 N80.5
F01.B11 F01.51 I31.39 I31.3 N80.221 N80.2
F03.C3 F03.91 M93.042 M93.012 N80.512 N80.5
F01.B18 F01.51 I34.81 I34.8 N80.222 N80.2
F03.C4 F03.91 M93.043 M93.013 N80.519 N80.5
F01.B2 F01.51 I34.89 I34.8 N80.223 N80.2
F06.70 G31.84 M93.044 M93.011 & N80.521 N80.5
F01.B3 F01.51 I47.20 I47.2 M93.012 N80.229 N80.2
F01.B4 F01.51 F06.71 G31.84 N80.30 N80.3 N80.522 N80.5
I47.21 I47.2 M93.051 M93.031
F01.C0 F01.50 F10.90 Z72.89 N80.311 N80.3 N80.529 N80.5
I47.29 I47.2 M93.052 M93.032
F01.C11 F01.51 F10.91 Z72.89 N80.312 N80.3 N80.531 N80.5
I71.010 I71.01 M93.053 M93.033
F01.C18 F01.51 F11.91 F11.90 N80.319 N80.3 N80.532 N80.5
I71.011 I71.01 M93.054 M93.031 &
F01.C2 F01.51 F12.91 F12.90 M93.032 N80.321 N80.3 N80.539 N80.5

ICD-10-CM 2024 xiii

 Neoplasm, abdomen, abdominal ICD-10-CM 2024

Unspecified

Unspecified
Secondary

Secondary
Malignant

Malignant

Malignant

Malignant
Neoplasm Table

Uncertain

Uncertain
Ca in situ

Ca in situ
Behavior

Behavior

Behavior

Behavior
Primary

Primary
Benign

Benign
Neoplasm, neoplastic
Note: The list below gives the code number for neoplasms by anatomical
— continued
site. For each site there are six possible code numbers according to whether antrum (Highmore)
the neoplasm in question is malignant, benign, in situ, of uncertain behavior, (maxillary) C31.0 C78.39 D02.3 D14.0 D38.5 D49.1
or of unspecified nature. The description of the neoplasm will often indicate pyloric C16.3 C78.89 D00.2 D13.1 D37.1 D49.0
which of the six columns is appropriate; e.g., malignant melanoma of skin, tympanicum C30.1 C78.39 D02.3 D14.0 D38.5 D49.1
benign fibroadenoma of breast, carcinoma in situ of cervix uteri. Where anus, anal C21.0 C78.5 D01.3 D12.9 D37.8 D49.0
such descriptors are not present, the remainder of the Index should be canal C21.1 C78.5 D01.3 D12.9 D37.8 D49.0
consulted where guidance is given to the appropriate column for each cloacogenic
morphological (histological) variety listed; e.g., Mesonephroma – see zone C21.2 C78.5 D01.3 D12.9 D37.8 D49.0
Neoplasm, malignant; Embryoma — see also Neoplasm, uncertain behavior; margin — see also
Disease, Bowen’s – see Neoplasm, skin, in situ. However, the guidance in Neoplasm, anus,
the Index can be overridden if one of the descriptors mentioned above is skin C44.500 C79.2 D04.5 D23.5 D48.5 D49.2
present; e.g., malignant adenoma of colon is coded to C18.9 and not to overlapping lesion
D12.6 as the adjective “malignant” overrides the Index entry “Adenoma — with
see also Neoplasm, benign, by site.” Codes listed with a dash -, following rectosigmoid
the code have a required additional character for laterality. The tabular list junction or
must be reviewed for the complete code. rectum C21.8 — — — — —
Neoplasm, skin C44.500 C79.2 D04.5 D23.5 D48.5 D49.2
neoplastic C80.1 C79.9 D09.9 D36.9 D48.9 D49.9 basal cell
abdomen, carcinoma C44.510 — — — — —
abdominal C76.2 C79.8-S D09.8 D36.7 D48.7 D49.89 specified type
cavity C76.2 C79.8-S D09.8 D36.7 D48.7 D49.89 NEC C44.590 — — — — —
organ squamous cell
C79.8-S

E
C76.2 D09.8 D36.7 D48.7 D49.89
carcinoma C44.520 — — — — —
viscera C76.2 C79.8-S D09.8 D36.7 D48.7 D49.89
sphincter C21.1 C78.5 D01.3 D12.9 D37.8 D49.0
wall — see also
aorta (thoracic) C49.3 C79.89 — D21.3 D48.1 D49.2
Neoplasm,
abdominal C49.4 C79.89 — D21.4 D48.1 D49.2
abdomen, wall,
aortic body C75.5 C79.89 — D35.6 D44.7 D49.7
skin C44.509 C79.2 D04.5 D23.5 D48.5 D49.2
aponeurosis C49.9 C79.89 — D21.9 D48.1 D49.2
connective

skin
tissue

basal cell
carcinoma
specified type
NEC
squamous cell
carcinoma
abdominopelvic
accessory sinus — see
Neoplasm, sinus
acoustic nerve
C49.4
C44.509

C44.519

C44.599

C44.529
C76.8

C72.4-S C79.49
C79.8-S —
—

—
—

—
C79.8-S —
—

—
D21.4
—

—
D36.7
PL D48.1
—

—
D48.7
D49.2
—

—
D49.89
palmar
plantar
appendix
arachnoid
cerebral
spinal
areola
arm NEC
artery — see Neoplasm,
connective tissue
aryepiglottic fold
hypopharyngeal
C49.1-S
C49.2-S
C18.1
C70.9
C70.0
C70.1
C50.0-S
C76.4-S

C13.1
C79.89
C79.89
C78.5
C79.49
C79.32
C79.49
C79.81
C79.89

C79.89
—
—
D01.0
—
—
—
D05-S
D04.6-S

D00.08
D21.1-S
D21.2-S
D12.1
D32.9
D32.0
D32.1
D24-S
D36.7

D10.7
D48.1
D48.1
D37.3
D42.9
D42.0
D42.1
D48.6-S
D48.7

D37.05
D49.2
D49.2
D49.0
D49.7
D49.7
D49.7
D49.3
D49.89

D49.0
M
— D33.3 D43.3 D49.7
adenoid (pharynx) aspect C13.1 C79.89 D00.08 D10.7 D37.05 D49.0
(tissue) C11.1 C79.89 D00.08 D10.6 D37.05 D49.0 laryngeal aspect C32.1 C78.39 D02.0 D14.1 D38.0 D49.1
adipose tissue — see marginal zone C13.1 C79.89 D00.08 D10.7 D37.05 D49.0
also Neoplasm, arytenoid
connective (cartilage) C32.3 C78.39 D02.0 D14.1 D38.0 D49.1
tissue C49.4 C79.89 — D21.9 D48.1 D49.2 fold — see Neoplasm,
adnexa (uterine) C57.4 C79.89 D07.39 D28.7 D39.8 D49.59 aryepiglottic
Neoplasm, abdomen, abdominal — Neoplasm, bile or biliary

adrenal associated with

C74.9-S C79.7-S D09.3 D35.0-S D44.1-S D49.7
transplanted
capsule C74.9-S C79.7-S D09.3 D35.0-S D44.1-S D49.7
organ C80.2 — — — — —
SA

cortex C74.0-S C79.7-S D09.3 D35.0-S D44.1-S D49.7 atlas C41.2 C79.51 — D16.6 D48.0 D49.2
gland C74.9-S C79.7-S D09.3 D35.0-S D44.1-S D49.7 atrium, cardiac C38.0 C79.89 — D15.1 D48.7 D49.89
medulla C74.1-S C79.7-S D09.3 D35.0-S D44.1-S D49.7 auditory
ala nasi (external) — canal (external)
see also Neoplasm, (skin) C44.20-S C79.2 D04.2-S D23.2-S D48.5 D49.2
skin, nose C44.301 C79.2 D04.39 D23.39 D48.5 D49.2 internal C30.1 C78.39 D02.3 D14.0 D38.5 D49.1
alimentary canal or nerve C72.4-S C79.49 — D33.3 D43.3 D49.7
tract NEC C26.9 C78.80 D01.9 D13.9 D37.9 D49.0 tube C30.1 C78.39 D02.3 D14.0 D38.5 D49.1
alveolar C03.9 C79.89 D00.03 D10.39 D37.09 D49.0 opening C11.2 C79.89 D00.08 D10.6 D37.05 D49.0
mucosa C03.9 C79.89 D00.03 D10.39 D37.09 D49.0 auricle, ear — see also
lower C03.1 C79.89 D00.03 D10.39 D37.09 D49.0 Neoplasm, skin,
upper C03.0 C79.89 D00.03 D10.39 D37.09 D49.0 ear C44.20-S C79.2 D04.2-S D23.2-S D48.5 D49.2
ridge or process C41.1 C79.51 — D16.5 D48.0 D49.2 auricular canal
carcinoma C03.9 C79.8-S — — — — (external) — see
lower C03.1 C79.8-S — — — — also Neoplasm, skin,
upper C03.0 C79.8-S — — — — ear C44.20-S C79.2 D04.2-S D23.2-S D48.5 D49.2
lower C41.1 C79.51 — D16.5 D48.0 D49.2 internal C30.1 C78.39 D02.3 D14.0 D38.5 D49.2
mucosa C03.9 C79.89 D00.03 D10.39 D37.09 D49.0 autonomic nerve or
lower C03.1 C79.89 D00.03 D10.39 D37.09 D49.0 nervous system
upper C03.0 C79.89 D00.03 D10.39 D37.09 D49.0 NEC (see Neoplasm,
upper C41.0 C79.51 — D16.4 D48.0 D49.2 nerve, peripheral)
sulcus C06.1 C79.89 D00.02 D10.39 D37.09 D49.0 axilla, axillary C76.1 C79.89 D09.8 D36.7 D48.7 D49.89
alveolus C03.9 C79.89 D00.03 D10.39 D37.09 D49.0 fold — see also
lower C03.1 C79.89 D00.03 D10.39 D37.09 D49.0 Neoplasm, skin,
upper C03.0 C79.89 D00.03 D10.39 D37.09 D49.0 trunk C44.509 C79.2 D04.5 D23.5 D48.5 D49.2
ampulla of Vater C24.1 C78.89 D01.5 D13.5 D37.6 D49.0 back NEC C76.8 C79.89 D04.5 D36.7 D48.7 D49.89
ankle NEC C76.5-S C79.89 D04.7-S D36.7 D48.7 D49.89 Bartholin's gland C51.0 C79.82 D07.1 D28.0 D39.8 D49.59
anorectum, anorectal basal ganglia C71.0 C79.31 — D33.0 D43.0 D49.6
(junction) C21.8 C78.5 D01.3 D12.9 D37.8 D49.0 basis pedunculi C71.7 C79.31 — D33.1 D43.1 D49.6
antecubital fossa or bile or biliary
space C76.4-S C79.89 D04.6-S D36.7 D48.7 D49.89 (tract) C24.9 C78.89 D01.5 D13.5 D37.6 D49.0

342 S Additional Character Required — Refer to the Tabular List for Character Selection
ICD-10-CM 2024 Chapter 2. Neoplasms Guidelines and Examples

Chapter 2. Neoplasms
Chapter 2. Neoplasms (C00–D49)

Chapter-specific Guidelines with Coding Examples b. Admission/Encounter for treatment of secondary site
The chapter-specific guidelines from the ICD-10-CM Official Guidelines for When a patient is admitted because of a primary neoplasm with metastasis
Coding and Reporting have been provided below. Along with these guidelines and treatment is directed toward the secondary site only, the secondary
are coding examples, contained in the shaded boxes, that have been developed neoplasm is designated as the principal diagnosis even though the primary
to help illustrate the coding and/or sequencing guidance found in these malignancy is still present.
guidelines. Patient with unresolved primary prostate cancer is admitted for
respiratory care and rehabilitation related to new diagnosis of right lung
General guidelines metastasis.
Chapter 2 of the ICD-10-CM contains the codes for most benign and all
malignant neoplasms. Certain benign neoplasms, such as prostatic adenomas, C78.01 Secondary malignant neoplasm of right lung
may be found in the specific body system chapters. To properly code a neoplasm, C61 Malignant neoplasm of prostate
it is necessary to determine from the record if the neoplasm is benign, in-situ,
malignant, or of uncertain histologic behavior. If malignant, any secondary Explanation: The patient was admitted for treatment of the secondary
(metastatic) sites should also be determined. neoplastic disease of the right lung with respiratory care. The code for the
secondary lung metastasis is sequenced before the code for primary
Primary malignant neoplasms overlapping site boundaries prostate cancer.
A primary malignant neoplasm that overlaps two or more contiguous (next
to each other) sites should be classified to the subcategory/code .8
('overlapping lesion'), unless the combination is specifically indexed c. Coding and sequencing of complications
elsewhere. For multiple neoplasms of the same site that are not contiguous Coding and sequencing of complications associated with the malignancies or
such as tumors in different quadrants of the same breast, codes for each site with the therapy thereof are subject to the following guidelines:
should be assigned. 1) Anemia associated with malignancy

E
A 73-year-old white female with a large rapidly growing malignant tumor When admission/encounter is for management of an anemia associated
in the left breast extending from the upper outer quadrant into the with the malignancy, and the treatment is only for anemia, the
axillary tail. appropriate code for the malignancy is sequenced as the principal or
first-listed diagnosis followed by the appropriate code for the anemia
C50.812 Malignant neoplasm of overlapping sites of left female (such as code D63.0, Anemia in neoplastic disease).
breast

PL
Explanation: Because this is a single large tumor that overlaps two
contiguous sites, a single code for overlapping sites is assigned.

A 52-year old white female with two distinct lesions of the right breast,
one (0.5 cm) in the upper outer quadrant and a second (1.5 cm) in the
lower outer quadrant; path report indicates both lesions are malignant
C50.411

C50.511
Malignant neoplasm of upper-outer quadrant of right
female breast
Malignant neoplasm of lower-outer quadrant of right
Patient is admitted for treatment of anemia in advanced colon cancer.
C18.9
D63.0
Malignant neoplasm of colon, unspecified
Anemia in neoplastic disease
Explanation: Even though the admission was solely to treat the anemia,
this guideline indicates that the code for the malignancy is sequenced
first.

2) Anemia associated with chemotherapy, immunotherapy and

radiation therapy
When the admission/encounter is for management of an anemia
M
female breast
associated with an adverse effect of the administration of chemotherapy
Explanation: This patient has two distinct malignant lesions of right breast or immunotherapy and the only treatment is for the anemia, the anemia
in adjacent quadrants. Because the lesions are not contiguous, two codes code is sequenced first followed by the appropriate codes for the
are reported. neoplasm and the adverse effect (T45.1X5, Adverse effect of
antineoplastic and immunosuppressive drugs).
Malignant neoplasm of ectopic tissue When the admission/encounter is for management of an anemia
Malignant neoplasms of ectopic tissue are to be coded to the site of origin associated with an adverse effect of radiotherapy, the anemia code
mentioned, e.g., ectopic pancreatic malignant neoplasms involving the should be sequenced first, followed by the appropriate neoplasm code
stomach are coded to malignant neoplasm of pancreas, unspecified (C25.9). and code Y84.2, Radiological procedure and radiotherapy as the cause of
SA

The neoplasm table in the Alphabetic Index should be referenced first. However, abnormal reaction of the patient, or of later complication, without
if the histological term is documented, that term should be referenced first, mention of misadventure at the time of the procedure.
rather than going immediately to the Neoplasm Table, in order to determine
which column in the Neoplasm Table is appropriate. For example, if the A 65-year-old female is admitted following hospitalization for multiple
documentation indicates “adenoma,” refer to the term in the Alphabetic Index to blood transfusions to treat anemia secondary to radiation therapy. She
review the entries under this term and the instructional note to “see also has been receiving radiation treatments for right breast cancer.
neoplasm, by site, benign.” The table provides the proper code based on the type D64.89 Other specified anemias
of neoplasm and the site. It is important to select the proper column in the table
that corresponds to the type of neoplasm. The Tabular List should then be C50.911 Malignant neoplasm of unspecified site of right
referenced to verify that the correct code has been selected from the table and female breast
that a more specific site code does not exist. Y84.2 Radiological procedure and radiotherapy as the cause
See Section I.C.21. Factors influencing health status and contact with health of abnormal reaction of the patient, or of later
services, Status, for information regarding Z15.0, codes for genetic susceptibility to complication, without mention of misadventure at
cancer. the time of the procedure

a. Admission/Encounter for treatment of primary site Explanation: The code for the anemia is sequenced first, followed by
the code for the malignancy, and last the code for the abnormal
If the malignancy is chiefly responsible for occasioning the patient reaction due to radiotherapy.
admission/encounter and treatment is directed at the primary site,
designate the primary malignancy as the principal/first-listed diagnosis. 3) Management of dehydration due to the malignancy
The only exception to this guideline is if the administration of chemotherapy, When the admission/encounter is for management of dehydration due to
immunotherapy or external beam radiation therapy is chiefly responsible the malignancy and only the dehydration is being treated (intravenous
for occasioning the admission/encounter. In that case, assign the rehydration), the dehydration is sequenced first, followed by the code(s)
appropriate Z51.-- code as the first-listed or principal diagnosis, and the for the malignancy.
underlying diagnosis or problem for which the service is being performed as
a secondary diagnosis.

ICD-10-CM 2024 473

 ICD-10-CM 2024 Chapter 4. Endocrine, Nutritional and Metabolic Diseases E08.3–E08.620
c E08.3 Diabetes mellitus due to underlying condition with E08.36 Diabetes mellitus due to underlying condition with

Chapter 4. Endocrine, Nutritional and Metabolic Diseases

ophthalmic complications diabetic cataract W
AHA: 2016,4Q,11-13 AHA: 2019,2Q,30-31; 2016,4Q,142
One of the following 7th characters is to be assigned to codes g E08.37 Diabetes mellitus due to underlying condition with
in subcategories E08.32, E08.33, E08.34, E08.35, and E08.37 diabetic macular edema, resolved following
to designate laterality of the disease: treatment W
1 right eye E08.39 Diabetes mellitus due to underlying condition with
2 left eye other diabetic ophthalmic complication W
3 bilateral Use additional code to identify manifestation, such
9 unspecified eye as:
diabetic glaucoma (H40-H42)
d E08.31 Diabetes mellitus due to underlying condition with
c E08.4 Diabetes mellitus due to underlying condition with
unspecified diabetic retinopathy
neurological complications
DEF: Diabetic retinopathy: Diabetic complication from
damage to the retinal vessels resulting in vision E08.40 Diabetes mellitus due to underlying condition with
problems that can progress to blindness. diabetic neuropathy, unspecified WUV
E08.311 Diabetes mellitus due to underlying E08.41 Diabetes mellitus due to underlying condition with
condition with unspecified diabetic diabetic mononeuropathy W
retinopathy with macular E08.42 Diabetes mellitus due to underlying condition with
edema WUV diabetic polyneuropathy WUV
E08.319 Diabetes mellitus due to underlying Diabetes mellitus due to underlying condition with
condition with unspecified diabetic diabetic neuralgia
retinopathy without macular edema W E08.43 Diabetes mellitus due to underlying condition with
d E08.32 Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy WUV
mild nonproliferative diabetic retinopathy Diabetes mellitus due to underlying condition with
Diabetes mellitus due to underlying condition with diabetic gastroparesis
nonproliferative diabetic retinopathy NOS AHA: 2013,4Q,114

E
e E08.321 Diabetes mellitus due to underlying E08.44 Diabetes mellitus due to underlying condition with
condition with mild nonproliferative diabetic amyotrophy W
diabetic retinopathy with macular E08.49 Diabetes mellitus due to underlying condition with
edema WUV other diabetic neurological complication W
e E08.329 Diabetes mellitus due to underlying c E08.5 Diabetes mellitus due to underlying condition with
condition with mild nonproliferative circulatory complications

d
edema

PL
diabetic retinopathy without macular

E08.33 Diabetes mellitus due to underlying condition with

moderate nonproliferative diabetic retinopathy
e E08.331 Diabetes mellitus due to underlying
condition with moderate nonproliferative
diabetic retinopathy with macular
edema
e E08.339 Diabetes mellitus due to underlying
WUV

condition with moderate nonproliferative

diabetic retinopathy without macular
edema
W

W
E08.51 Diabetes mellitus due to underlying condition with
diabetic peripheral angiopathy without
gangrene
AHA: 2018,3Q,3-4; 2018,2Q,7
E08.52 Diabetes mellitus due to underlying condition with
diabetic peripheral angiopathy with gangrene W
Diabetes mellitus due to underlying condition with
diabetic gangrene
AHA: 2020,2Q,18; 2018,3Q,3; 2018,2Q,7; 2017,4Q,102
E08.59 Diabetes mellitus due to underlying condition with
other circulatory complications
W

W
M
d E08.34 Diabetes mellitus due to underlying condition with c E08.6 Diabetes mellitus due to underlying condition with other
severe nonproliferative diabetic retinopathy specified complications
e E08.341 Diabetes mellitus due to underlying d E08.61 Diabetes mellitus due to underlying condition with
condition with severe nonproliferative diabetic arthropathy
diabetic retinopathy with macular E08.610 Diabetes mellitus due to underlying
edema WUV condition with diabetic neuropathic
e E08.349 Diabetes mellitus due to underlying arthropathy W
condition with severe nonproliferative Diabetes mellitus due to underlying
diabetic retinopathy without macular condition with Charcôt's joints
SA

edema W DEF: Charcot’s joint: Progressive neurologic

d E08.35 Diabetes mellitus due to underlying condition with arthropathy in which chronic degeneration
proliferative diabetic retinopathy of joints in the weight-bearing areas with
e E08.351 Diabetes mellitus due to underlying peripheral hypertrophy occurs as a
condition with proliferative diabetic complication of a neuropathy disorder.
retinopathy with macular Supporting structures relax from a loss of
edema WUV sensation resulting in chronic joint
e E08.352 Diabetes mellitus due to underlying instability.
condition with proliferative diabetic E08.618 Diabetes mellitus due to underlying
retinopathy with traction retinal condition with other diabetic
detachment involving the macula W arthropathy W
e E08.353 Diabetes mellitus due to underlying AHA: 2018,2Q,6
condition with proliferative diabetic
retinopathy with traction retinal d E08.62 Diabetes mellitus due to underlying condition with
detachment not involving the skin complications
macula W E08.620 Diabetes mellitus due to underlying
condition with diabetic dermatitis W
e E08.354 Diabetes mellitus due to underlying Diabetes mellitus due to underlying
condition with proliferative diabetic
retinopathy with combined traction retinal condition with diabetic necrobiosis
detachment and rhegmatogenous retinal lipoidica
detachment W
E08.3–E08.620

e E08.355 Diabetes mellitus due to underlying

condition with stable proliferative diabetic
retinopathy W
e E08.359 Diabetes mellitus due to underlying
condition with proliferative diabetic
retinopathy without macular edema W

S Additional Character Required g Placeholder Alert 8 Newborn: 0 9 Pediatric: 0-17 x Maternity: 9-64 y Adult: 15-124
ICD-10-CM 2024 531
 ICD-10-CM 2024 Chapter 6. Diseases of the Nervous System G40.11–G40.509
d G40.11 Localization-related (focal) (partial) symptomatic G40.A19 Absence epileptic syndrome, intractable,

Chapter 6. Diseases of the Nervous System

epilepsy and epileptic syndromes with simple without status epilepticus
partial seizures, intractable c G40.B Juvenile myoclonic epilepsy [impulsive petit mal]
G40.111 Localization-related (focal) (partial)
symptomatic epilepsy and epileptic d G40.B0 Juvenile myoclonic epilepsy, not intractable
syndromes with simple partial seizures, G40.B01 Juvenile myoclonic epilepsy, not
intractable, with status epilepticus intractable, with status epilepticus
G40.119 Localization-related (focal) (partial) G40.B09 Juvenile myoclonic epilepsy, not
symptomatic epilepsy and epileptic intractable, without status epilepticus
syndromes with simple partial seizures, d G40.B1 Juvenile myoclonic epilepsy, intractable
intractable, without status epilepticus G40.B11 Juvenile myoclonic epilepsy, intractable,
c G40.2 Localization-related (focal) (partial) symptomatic epilepsy with status epilepticus
and epileptic syndromes with complex partial seizures G40.B19 Juvenile myoclonic epilepsy, intractable,
Attacks with alteration of consciousness, often with without status epilepticus
automatisms c G40.4 Other generalized epilepsy and epileptic syndromes
Complex partial seizures developing into secondarily Epilepsy with grand mal seizures on awakening
generalized seizures Epilepsy with myoclonic absences
d G40.20 Localization-related (focal) (partial) symptomatic Epilepsy with myoclonic-astatic seizures
epilepsy and epileptic syndromes with complex Grand mal seizure NOS
partial seizures, not intractable
Nonspecific atonic epileptic seizures
Localization-related (focal) (partial) symptomatic
Nonspecific clonic epileptic seizures
epilepsy and epileptic syndromes with complex
Nonspecific myoclonic epileptic seizures
partial seizures without intractability
Nonspecific tonic epileptic seizures
G40.201 Localization-related (focal) (partial)
symptomatic epilepsy and epileptic Nonspecific tonic-clonic epileptic seizures
syndromes with complex partial seizures, Symptomatic early myoclonic encephalopathy
not intractable, with status epilepticus d G40.40 Other generalized epilepsy and epileptic

E
G40.209 Localization-related (focal) (partial) syndromes, not intractable
symptomatic epilepsy and epileptic Other generalized epilepsy and epileptic syndromes
syndromes with complex partial seizures, without intractability
not intractable, without status Other generalized epilepsy and epileptic syndromes
epilepticus NOS
Localization-related (focal) (partial) G40.401 Other generalized epilepsy and epileptic

d
PL
symptomatic epilepsy and epileptic
syndromes with complex partial
seizures NOS
G40.21 Localization-related (focal) (partial) symptomatic
epilepsy and epileptic syndromes with complex
partial seizures, intractable
G40.211 Localization-related (focal) (partial)
symptomatic epilepsy and epileptic
syndromes with complex partial seizures,
intractable, with status epilepticus
G40.219 Localization-related (focal) (partial)
symptomatic epilepsy and epileptic
d
syndromes, not intractable, with status
epilepticus
G40.409 Other generalized epilepsy and epileptic
syndromes, not intractable, without
status epilepticus
G40.41 Other generalized epilepsy and epileptic
syndromes, intractable
G40.411 Other generalized epilepsy and epileptic
syndromes, intractable, with status
epilepticus
G40.419 Other generalized epilepsy and epileptic
syndromes, intractable, without status
M
syndromes with complex partial seizures, epilepticus
intractable, without status epilepticus G40.42 Cyclin-Dependent Kinase-Like 5 Deficiency Disorder
c G40.3 Generalized idiopathic epilepsy and epileptic syndromes CDKL5
Code also MERRF syndrome, if applicable (E88.42) Use additional code, if known, to identify associated
d G40.30 Generalized idiopathic epilepsy and epileptic manifestations, such as:
syndromes, not intractable cortical blindness (H47.61-)
Generalized idiopathic epilepsy and epileptic global development delay (F88)
syndromes without intractability AHA: 2020,4Q,18-19
SA

G40.301 Generalized idiopathic epilepsy and c G40.5 Epileptic seizures related to external causes
epileptic syndromes, not intractable, with Epileptic seizures related to alcohol
status epilepticus
Epileptic seizures related to drugs
G40.309 Generalized idiopathic epilepsy and
epileptic syndromes, not intractable, Epileptic seizures related to hormonal changes
without status epilepticus Epileptic seizures related to sleep deprivation
Generalized idiopathic epilepsy and Epileptic seizures related to stress
epileptic syndromes NOS Code also, if applicable, associated epilepsy and recurrent
d G40.31 Generalized idiopathic epilepsy and epileptic seizures (G40.-)
syndromes, intractable Use additional code for adverse effect, if applicable, to identify
G40.311 Generalized idiopathic epilepsy and drug (T36-T50 with fifth or sixth character 5)
epileptic syndromes, intractable, with d G40.50 Epileptic seizures related to external causes, not
status epilepticus intractable
G40.319 Generalized idiopathic epilepsy and G40.501 Epileptic seizures related to external
epileptic syndromes, intractable, without causes, not intractable, with status
status epilepticus epilepticus
c G40.A Absence epileptic syndrome G40.509 Epileptic seizures related to external
Childhood absence epilepsy [pyknolepsy] causes, not intractable, without status
epilepticus
Juvenile absence epilepsy
Epileptic seizures related to external
Absence epileptic syndrome, NOS
G40.11–G40.509

causes, NOS
d G40.A0 Absence epileptic syndrome, not intractable
G40.A01 Absence epileptic syndrome, not
intractable, with status epilepticus
G40.A09 Absence epileptic syndrome, not
intractable, without status epilepticus
d G40.A1 Absence epileptic syndrome, intractable
G40.A11 Absence epileptic syndrome, intractable,
with status epilepticus

S Additional Character Required g Placeholder Alert 8 Newborn: 0 9 Pediatric: 0-17 x Maternity: 9-64 y Adult: 15-124
ICD-10-CM 2024 591
 ICD-10-CM 2024 Chapter 20. External Causes of Morbidity Y92–Y92.096
b Y92 Place of occurrence of the external cause d Y92.02 Mobile home as the place of occurrence of the

Chapter 20. External Causes of Morbidity

The following category is for use, when relevant, to identify the place external cause
of occurrence of the external cause. Use in conjunction with an Y92.020 Kitchen in mobile home as the place of
activity code. occurrence of the external cause
Place of occurrence should be recorded only at the initial encounter for Y92.021 Dining room in mobile home as the place
of occurrence of the external cause
treatment
Y92.022 Bathroom in mobile home as the place of
c Y92.0 Non-institutional (private) residence as the place of occurrence of the external cause
occurrence of the external cause Y92.023 Bedroom in mobile home as the place of
1 abandoned or derelict house (Y92.89) occurrence of the external cause
home under construction but not yet occupied Y92.024 Driveway of mobile home as the place of
(Y92.6-) occurrence of the external cause
institutional place of residence (Y92.1-) Y92.025 Garage of mobile home as the place of
d Y92.00 Unspecified non-institutional (private) residence occurrence of the external cause
as the place of occurrence of the external cause Y92.026 Swimming-pool of mobile home as the
Y92.000 Kitchen of unspecified non-institutional place of occurrence of the external cause
(private) residence as the place of Y92.027 Garden or yard of mobile home as the
occurrence of the external cause place of occurrence of the external cause
Y92.001 Dining room of unspecified Y92.028 Other place in mobile home as the place
non-institutional (private) residence as of occurrence of the external cause
the place of occurrence of the external Y92.029 Unspecified place in mobile home as the
cause place of occurrence of the external cause
Y92.002 Bathroom of unspecified d Y92.03 Apartment as the place of occurrence of the
non-institutional (private) residence as external cause
the place of occurrence of the external Condominium as the place of occurrence of the
cause external cause
Y92.003 Bedroom of unspecified non-institutional Co-op apartment as the place of occurrence of the
(private) residence as the place of

E
external cause
occurrence of the external cause
Y92.030 Kitchen in apartment as the place of
Y92.007 Garden or yard of unspecified occurrence of the external cause
non-institutional (private) residence as
the place of occurrence of the external Y92.031 Bathroom in apartment as the place of
cause occurrence of the external cause
Y92.032 Bedroom in apartment as the place of

cause

PL
Y92.008 Other place in unspecified
non-institutional (private) residence as
the place of occurrence of the external

Y92.009 Unspecified place in unspecified

non-institutional (private) residence as
the place of occurrence of the external
cause
Home (NOS) as the place of occurrence of
the external cause
d Y92.01 Single-family non-institutional (private) house as
the place of occurrence of the external cause
occurrence of the external cause
Y92.038 Other place in apartment as the place of
occurrence of the external cause
Y92.039 Unspecified place in apartment as the
place of occurrence of the external cause
d Y92.04 Boarding-house as the place of occurrence of the
external cause
Y92.040 Kitchen in boarding-house as the place
of occurrence of the external cause
Y92.041 Bathroom in boarding-house as the place
of occurrence of the external cause
M
Farmhouse as the place of occurrence of the external Y92.042 Bedroom in boarding-house as the place
cause of occurrence of the external cause
1 barn (Y92.71) Y92.043 Driveway of boarding-house as the place
of occurrence of the external cause
chicken coop or hen house (Y92.72)
Y92.044 Garage of boarding-house as the place of
farm field (Y92.73) occurrence of the external cause
orchard (Y92.74) Y92.045 Swimming-pool of boarding-house as the
single family mobile home or trailer place of occurrence of the external cause
(Y92.02-) Y92.046 Garden or yard of boarding-house as the
SA

slaughter house (Y92.86) place of occurrence of the external cause

Y92.010 Kitchen of single-family (private) house Y92.048 Other place in boarding-house as the
as the place of occurrence of the external place of occurrence of the external cause
cause Y92.049 Unspecified place in boarding-house as
Y92.011 Dining room of single-family (private) the place of occurrence of the external
house as the place of occurrence of the cause
external cause d Y92.09 Other non-institutional residence as the place of
Y92.012 Bathroom of single-family (private) house occurrence of the external cause
as the place of occurrence of the external AHA: 2017,2Q,10
cause Y92.090 Kitchen in other non-institutional
Y92.013 Bedroom of single-family (private) house residence as the place of occurrence of
as the place of occurrence of the external the external cause
cause Y92.091 Bathroom in other non-institutional
Y92.014 Private driveway to single-family residence as the place of occurrence of
(private) house as the place of occurrence the external cause
of the external cause Y92.092 Bedroom in other non-institutional
Y92.015 Private garage of single-family (private) residence as the place of occurrence of
house as the place of occurrence of the the external cause
external cause Y92.093 Driveway of other non-institutional
Y92.016 Swimming-pool in single-family (private) residence as the place of occurrence of
house or garden as the place of the external cause
Y92–Y92.096

occurrence of the external cause Y92.094 Garage of other non-institutional

Y92.017 Garden or yard in single-family (private) residence as the place of occurrence of
house as the place of occurrence of the the external cause
external cause Y92.095 Swimming-pool of other non-institutional
Y92.018 Other place in single-family (private) residence as the place of occurrence of
house as the place of occurrence of the the external cause
external cause Y92.096 Garden or yard of other non-institutional
Y92.019 Unspecified place in single-family residence as the place of occurrence of
(private) house as the place of occurrence the external cause
of the external cause
S Additional Character Required g Placeholder Alert 8 Newborn: 0 9 Pediatric: 0-17 x Maternity: 9-64 y Adult: 15-124
ICD-10-CM 2024 1241
ICD-10-CM 2024 Appendix D: Qualifications for Medicare Coverage of Home Health Services

Appendix D: Qualifications for Medicare Coverage of Home Health Services

Appendix D: Qualifications for Medicare Coverage of Home Health Services
The criteria that must be met by the patient to qualify for Medicare coverage of Example 2: A patient who is being discharged from a hospital with a diagnosis of
home health services are specified in the following sections of the Medicare Benefit osteomyelitis and requires continuation of the I.V. antibiotic therapy that was
Policy Manual (Pub. 100-02), Chapter 7 - Home Health Services. begun in the hospital was found to meet the criteria for Medicare coverage of
skilled nursing facility services. If the patient also meets the qualifying criteria for
coverage of home health services, payment may be made for the reasonable and
Conditions to be Met for Coverage of necessary home health services the patient needs, notwithstanding the availability
of coverage in a skilled nursing facility.
Home Health Services Example 3: A patient who needs skilled nursing care on an intermittent basis also
Medicare covers HHA services when the following criteria are met:
hires a licensed practical (vocational) nurse to provide nighttime assistance while
1. The person to whom the services are provided is an eligible Medicare family members sleep. The care provided by the nurse, as respite to the family
beneficiary; members, does not require the skills of a licensed nurse (as defined in §40.1) and
2. The HHA that is providing the services to the beneficiary has in effect a valid therefore has no impact on the beneficiary’s eligibility for Medicare payment of
agreement to participate in the Medicare program; home health services even though another third party insurer may pay for that
3. The beneficiary qualifies for coverage of home health services as described nursing care.
in §30;
4. The services for which payment is claimed are covered as described in §§40 Use of Utilization Screens and “Rules of Thumb”
and 50; Medicare recognizes that determinations of whether home health services are
5. Medicare is the appropriate payer; and reasonable and necessary must be based on an assessment of each beneficiary’s
6. The services for which payment is claimed are not otherwise excluded from individual care needs. Therefore, denial of services based on numerical utilization
payment. screens, diagnostic screens, diagnosis or specific treatment norms is not
appropriate.

E
Reasonable and Necessary Services
Background: In enacting the Medicare program, Congress recognized that the
physician or allowed practitioner would play an important role in determining Conditions Patient Must Meet to Qualify
utilization of services. The law requires that payment can be made only if a
physician or allowed practitioner certifies the need for services and establishes a
for Coverage of Home Health Services

necessary.”

PL
plan of care. The Secretary is responsible for ensuring that Medicare covers the
claimed services, including determining whether they are “reasonable and

Determination of Coverage: The Medicare contractor’s decision on whether care

is reasonable and necessary is based on information reflected in the home health
plan of care, the OASIS as required by 42 CFR 484.55 or a medical record of the
individual patient. Medicare does not deny coverage solely on the basis of the
reviewer’s general inferences about patients with similar diagnoses or on data
related to utilization generally, but bases it upon objective clinical evidence
regarding the patient’s individual need for care.
To qualify for the Medicare home health benefit a Medicare beneficiary must meet
the following requirements:
• Be confined to the home;
• Under the care of a physician or allowed practitioner;
• Receiving services under a plan of care established and periodically reviewed
by a physician or allowed practitioner;
• Be in need of skilled nursing care on an intermittent basis or physical therapy
or speech-language pathology; or
• Have a continuing need for occupational therapy.
M
Coverage of skilled nursing care or therapy to perform a maintenance program For purposes of benefit eligibility, “intermittent” means skilled nursing care that is
does not turn on presence or absence of a patient’s potential for improvement from either provided or needed on fewer than seven days each week or less than eight
nursing care or therapy, but rather on the patient’s need for skilled care. Skilled care hours of each day for periods of 21 days or less (with extensions in exceptional
may be necessary to improve a patient’s current condition, to maintain the patient’s circumstances when the need for additional care is finite and predictable).
current condition, or to prevent or slow further deterioration of the patient’s
condition. A patient must meet each of the criteria specified in this section. Patients who meet
each of these criteria are eligible to have payment made on their behalf for services
discussed in §§40 and 50.
Impact of Other Available Caregivers and Other
SA

Available Coverage on Medicare Coverage of Home Confined to the Home

Health Services For a patient to be eligible to receive covered home health services under both Part
Where the Medicare criteria for coverage of home health services are met, patients A and Part B, the law requires that a physician or allowed practitioner certify in all
are entitled by law to coverage of reasonable and necessary home health services. cases that the patient is confined to his/her home. For purposes of the statute, an
Therefore, a patient is entitled to have the costs of reasonable and necessary individual shall be considered “confined to the home” (homebound) if the
services reimbursed by Medicare without regard to whether there is someone following two criteria are met:
available to furnish the services. However, where a family member or other person
1. Criterion-One:
is or will be providing services that adequately meet the patient’s needs, it would
not be reasonable and necessary for HHA personnel to furnish such services. The patient must either:
Ordinarily it can be presumed that there is no able and willing person in the home • Because of illness or injury, need the aid of supportive devices such as
to provide the services being rendered by the HHA unless the patient or family crutches, canes, wheelchairs, and walkers; the use of special transportation;
indicates otherwise and objects to the provision of the services by the HHA, or or the assistance of another person in order to leave their place of residence
unless the HHA has first hand knowledge to the contrary. OR
Similarly, a patient is entitled to reasonable and necessary Medicare home health • Have a condition such that leaving his or her home is medically
services even if the patient would qualify for institutional care (e.g., hospital care or contraindicated.
skilled nursing facility care) and Medicare payment should be made for reasonable If the patient meets one of the criterion-one conditions, then the patient must also
and necessary home health services where the patient is also receiving meet two additional requirements defined in criterion two below.
supplemental services that do not meet Medicare’s definition of skilled nursing
2. Criterion-Two:
care or home health aide services.
• There must exist a normal inability to leave home;
Example 1: A patient who lives with an adult daughter and otherwise qualifies for
Medicare coverage of home health services, requires the assistance of a home AND
health aide for bathing and assistance with an exercise program to improve • Leaving home must require a considerable and taxing effort.
endurance. The daughter is unwilling to bathe her elderly father and assist him To clarify, in determining whether the patient meets criterion two of the
with the exercise program. Home health aide services would be reasonable and homebound definition, the clinician needs to take into account the illness or injury
necessary. for which the patient met criterion one and consider the illness or injury in the
context of the patient’s overall condition. The clinician is not required to include

ICD-10-CM 2024 Appendixes – 23

Appendix F: OASIS Diagnosis Guidance Appendix F: OASIS Diagnosis Guidance ICD-10-CM 2024

Appendix F: OASIS Diagnosis Guidance

A draft version of the new Outcome and Assessment Information Set data set Chapter 3 contains item-by-item guidance for all OASIS items. Included here are
(OASIS-E) was made available on the Centers for Medicare and Medicaid Services only the items which pertain to assigning an ICD-10-CM diagnosis code, item
(CMS) OASIS Data Sets webpage on March 18, 2020. OASIS-E was scheduled to M1021, M1023 and M1028.
replace OASIS-D effective January 01, 2023. Please note this version of the OASIS is Note: CY 2023 updates to the OASIS Guidance Manual were not available at the
not yet final; approval is expected later this year. The release of the updated version time this book was printed. Updated versions can be found at https://
of the OASIS will be delayed until January 1st of the year that is at least one full www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/
calendar year after the end of the COVID-19 PHE. HomeHealthQualityInits/HHQIOASISUserManual.html.
In order to provide maximum flexibilities for home health agencies (HHAs) to For each item, guidance is provided on the following topics:
respond to the COVID-19 public health emergency (PHE), CMS is delaying the
release of the OASIS-E data set needed to support the Transfer of Health (TOH) ITEM INTENT: Describes the rationale for collecting the information, in the
Information Quality Measures and new or revised Standardized Patient Assessment context of outcome and process quality measurement, care planning, outcome
Data Elements (SPADEs). risk adjustment, or prospective payment rate adjustment.
TIME POINTS: Describes when the information is to be collected during the
The following information outlines diagnosis reporting on the OASIS-D data set. patient’s home health episode of care.
The Outcome and Assessment Information Set (OASIS-D) includes three OASIS RESPONSE-SPECIFIC INSTRUCTIONS: Describes how the clinician should decide
M-items related to ICD-10-CM codes. These items are: which of the possible responses should apply. These instructions may not
M1021 Primary Diagnosis always provide definitive guidance for selecting responses in every case,
because clinical judgement is often required to determine the most accurate
M1023 Other Diagnoses
response to a specific item.
M1028 Active Diagnoses-Comorbidities and Co-existing Conditions
DATA SOURCES/RESOURCES: Describes the potential sources of information
The last item listed, M1028 Active Diagnoses-Comorbidities and Co-existing that should be accessed during the assessment to determine the most accurate

E
Conditions, while tied to specific ICD-10-CM related diagnostic conditions, does not response to this specific item. May include other clinicians, administrative
require the assignment of ICD-10-CM codes. records, online guidance regarding coding or other assessment guidelines, or
For the purpose of payment and compliance, ICD-10-CM diagnoses assigned for a standards promulgated by professional or accrediting organizations.
given episode will be represented on: In addition to the information provided in the tables, items M1021 and M1023 also
have specific instructions related to reporting diagnoses in the various columns on
• OASIS-D comprehensive assessment

• Home health claim submitted for period of care

PL
• Plan of care (POC), which is reviewed and signed by the certifying physician

Diagnoses listed on the claim should follow the OASIS definitions for primary and
secondary diagnosis found in the OASIS Guidance Manual. Only current diagnoses
actively addressed in the plan of care (POC) or that have the potential to affect the
patient’s responsiveness to treatment and rehabilitative prognosis even if not the
focus of any home health treatment itself. Exclude resolved diagnoses or those that
do not have the potential to impact the skilled services provided by the HHA, even
if they are known/documented diagnoses. It is expected that more secondary
the form which are as follows.
M1021/M1023
Diagnoses and Symptom Control:
List each diagnosis for which the patient is receiving home care in Column 1, and
enter its ICD-10-CM code at the level of highest specificity in Column 2 (diagnosis
codes only—no surgical or procedure codes allowed). Diagnoses are listed in the
order that best reflects the seriousness of each condition and supports the
disciplines and services provided. Rate the degree of symptom control for each
condition in Column 2. ICD-10-C M sequencing requirements must be followed if
multiple coding is indicated for any diagnoses.
M
diagnoses would be reported on the home health claim given the increased Code each row according to the following directions for each column:
number of secondary diagnosis fields compared to the OASIS item set. Column 1: Enter the description of the diagnosis. Sequencing of diagnoses should
For case-mix adjustment purposes, the principal diagnosis reported on the home reflect the seriousness of each condition and support the disciplines and services
health claim will determine the clinical group for each 30-day period of care. CMS provided.
has updated billing instructions to clarify that there will be no need for the HHA to Column 2: Enter the ICD-10-CM code for the condition described in Column 1 - no
complete a follow up assessment just to make the diagnoses on the claim and the surgical or procedure codes allowed. Codes must be entered at the level of highest
OASIS form match. specificity and ICD-10-CM coding rules and sequencing requirements must be
However, for both the claim and the OASIS, the ICD-10-CM diagnoses should be followed. Note that external cause codes (ICD-10-CM codes beginning with V, W, X,
SA

listed in the order that best reflects the seriousness of the patient’s condition and or Y) may not be reported in M1021 (Primary Diagnosis) but may be reported in
justifies the disciplines and services provided and in accordance with the Official M1023 (Secondary Diagnoses). Also note that when a Z-code is reported in Column
ICD-10-CM Guidelines for Coding and Reporting. The sequence of codes should 2, the code for the underlying condition can often be entered in Column 2, as long
follow ICD-10-CM guidelines for reporting manifestation codes. Therefore, if a as it is an active on-going condition impacting home health care.
manifestation code is part of the primary diagnosis, the first two diagnoses should Rate the degree of symptom control for the condition listed in Column 1. Do not
match and appear in the same sequence on both forms. assign a symptom control rating if the diagnosis code is a V, W, X, Y or Z-code.
The ICD-10-CM diagnoses entered onto the OASIS and claim form must be the full Choose one value that represents the degree of symptom control appropriate for
diagnosis code, all seven characters, where applicable. If the complete, valid code each diagnosis using the following scale:
has fewer than the maximum number of characters, allowed on the form, it is not 0—Asymptomatic, no treatment needed at this time
appropriate to fill it with zeros or other characters. 1—Symptoms well controlled with current therapy
CMS has clarified “Active Diagnoses” for the purpose of assignment to M1021, 2—Symptoms controlled with difficulty, affecting daily functioning; patient
M1023 and responses to M1028 with the following taken from Quarterly Q&As: needs ongoing monitoring
• Diagnoses that are the chief reason for home health services 3—Symptoms poorly controlled; patient needs frequent adjustment in
treatment and dose monitoring
• Comorbid condition that is addressed in the plan of care
4—Symptoms poorly controlled; history of re-hospitalizations
• Conditions felt to have potential to affect the patient’s responsiveness to
Note that the rating for symptom control in Column 2 should not be used to
treatment
determine the sequencing of the diagnoses listed in Column 1. These are separate
Diagnoses felt to have the potential to affect the patient’s responsiveness to items and sequencing may not coincide.
treatment means that they have a direct relationship to the patient’s current
functional, cognitive mood, or behavior status; medical treatments; nurse
monitoring; or risk of death at the time of assessment.
The following information can be found in the Outcome and Assessment
Information Set OASIS-D Guidance Manual, effective January 1, 2019, chapter 3,
section 3-C, “OASIS Item Guidance — Patient History and Diagnoses.”

32 – Appendixes ICD-10-CM 2024

ICD-10-CM 2024 Illustrations

Chapter 6. Diseases of the Nervous System (G00–G99)

Brain

Corpus callosum Septum pellucidum Fornix

CEREBRUM
Choroid plexus of
3rd ventricle
Interventricular
foramen
Thalamus

Pineal body

Hypothalamus

E
Optic chiasm Cerebral aqueduct

Mammillary body
CEREBELLUM
Hypophysis

BRAINSTEM
Midbrain
Pons
Medulla oblongata
PL Cranial Nerves
4th ventricle

Median aperture

Spinal cord
M
CN I: Olfactory nerve

Cerebrum CN II: Optic nerve

SA

CN III: Oculomotor nerve

CN IV: Trochlear nerve

CN V: Trigeminal nerve
CN VI: Abducens nerve

CN VII: Facial nerve

Nervus intermedius
(part of CN VII)

CN VIII: Vestibulocochlear nerve

Pons
CN IX: Glossopharyngeal nerve
CN X: Vagus nerve
Cerebellum
CN XII: Hypoglossal nerve

Spinal cord CN XI: Accessory nerve

ICD-10-CM 2024 Illustrations–9