ICD-10 Clinical Modification

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), for medical coding and reporting in the United States. The ICD-10-CM is a morbidity classification for classifying diagnoses and reason for visits in all American health care settings. The ICD-10-CM is based on the ICD-10, the statistical classification of disease published by the World Health Organization (WHO) which replaces ICD-9.

Conventions

General rules for use of the guidelines. They are incorporated within the ICD-10-CM as instructional notes.

Level of Detail in Coding

ICD-10-CM Diagnosis codes are to be used and reported at their highest number of digits available. They are composed of codes with 3, 4, 5, 6 or 7 digits. Three digits are used as the heading of a category of codes that may be further subdivided by the use of fourth and/or fifth digits (preceded by a decimal, i.e. A00.1 Cholera due to Vibrio cholerae 01, biovar eltor), which provides greater detail. A code is invalid if it has not been coded to the full number of characters required for that code, including the 7th character, if applicable.

Seventh character and placeholders

Some codes require the use of a seventh character for codes in chapters M, O, R, S, T, V, W, X, Y. If there are fewer than six characters in the code the placeholder "x" is used to ensure that the seventh character is always in the seventh position. Example S03.4xxA Sprain of jaw, initial encounter.

Excludes Notes

ICD-10-CM has two types of excludes notes.

• Exclude 1 - Indicates that the code excluded should never be used at the same time as the code in this section
• Exclude 2 - Indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time

CHAPTER 1 - Certain infectious and parasitic diseases (A00-B99)

This chapter contains the following blocks:

• A00-A09 Intestinal infectious diseases
• A15-A19 Tuberculosis
• A20-A28 Certain zoonotic bacterial diseases
• A30-A49 Other bacterial diseases
• A50-A64 Infections with a predominantly sexual mode of transmission
• A65-A69 Other spirochetal diseases
• A70-A74 Other diseases caused by chlamydiae
• A75-A79 Rickettsioses
• A80-A89 Viral infections of the central nervous system
• A90-A99 Arthropod-borne viral fevers and viral hemorrhagic fevers
• B00-B09 Viral infections characterized by skin and mucous membrane lesions
• 015-B19 Viral hepatitis
• B20 Human immunodeficiency virus [HIV] disease
• B25-B34 Other viral diseases
• B35-B49 Mycoses
• B50-B64 Protozoal diseases
• B65-B83 Helminthiases
• B85-B89 Pediculosis, acariasis and other infestations
• B90-B94 Sequelae of infectious and parasitic diseases
• B95-B97 Bacterial, viral and other infectious agents
• B99 Other infectious diseases

CHAPTER 2 - Neoplasms (C00-D48)

This chapter contains the following broad groups of neoplasms:

• C00-C75 Malignant neoplasms, stated or presumed to be primary (of specified sites), and certain specified histologies, except neuroendocrine, and of lymphoid, hematopoietic and related tissue

• C00-C14 Malignant neoplasms of lip, oral cavity and pharynx
• C15-C26 Malignant neoplasms of digestive organs
• C30-C39 Malignant neoplasms of respiratory and intrathoracic organs
• C40-C41 Malignant neoplasms of bone and articular cartilage
• C43-C44 Malignant neoplasms of skin
• C45-C49 Malignant neoplasms of mesothelial and soft tissue
• C50 Malignant neoplasms of breast
• C51-C58 Malignant neoplasms of female genital organs
• C60-C63 Malignant neoplasms of male genital organs
• C64-C68 Malignant neoplasms of urinary tract
• C69-C72 Malignant neoplasms of eye, brain and other parts of central nervous system
• C73-C75 Malignant neoplasms of thyroid and other endocrine glands

• C7a Malignant neuroendocrine tumors
• C7b Secondary neuroendocrine tumors
• C76-C80 Malignant neoplasms of ill-defined, other secondary and unspecified sites
• C81-C96 Malignant neoplasms of lymphoid, hematopoietic and related tissue
• D00-D09 In situ neoplasms
• D10-D36 Benign neoplasms, except benign neuroendocrine tumors
• D3a Benign neuroendocrine tumors
• D37-D48 Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes
• D49 Neoplasms of unspecified behavior

CHAPTER 3 - Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)

This chapter contains the following blocks:

• D50-D53 Nutritional anemias
• D55-D59 Hemolytic anemias
• D60-D64 Aplastic and other anemias and other bone marrow failure syndromes
• D65-D69 Coagulation defects, purpura and other hemorrhagic conditions
• D70-D77 Other disorders of blood and blood-forming organs
• D78 Intraoperative and postprocedural complications of spleen
• D80-D89 Certain disorders involving the immune mechanism

CHAPTER 4 - Endocrine, nutritional and metabolic diseases (E00-E90)

This chapter contains the following blocks:

• E00-E07 Disorders of thyroid gland
• E08-E13 Diabetes mellitus
• E15-E16 Other disorders of glucose regulation and pancreatic internal secretion
• E20-E35 Disorders of other endocrine glands
• E36 Intraoperative complications of endocrine system
• E40-E46 Malnutrition
• E50-E64 Other nutritional deficiencies
• E65-E68 Overweight, obesity and other hyperalimentation
• E70-E88 Metabolic disorders
• E89 Postprocedural endocrine and metabolic complications and disorders, not elsewhere classified

CHAPTER 5 - Mental and behavioral disorders (F01-F99)

This chapter contains the following blocks:

• F01-F09 Mental disorders due to known physiological conditions
• F10-F19 Mental and behavioral disorders due to psychoactive substance use
• F20-F29 Schizophrenia, schizotypal and delusional, and other non-mood psychotic disorders
• F30-F39 Mood [affective] disorders
• F40-F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders
• F50-F59 Behavioral syndromes associated with physiological disturbances and physical factors
• F60-F69 Disorders of adult personality and behavior
• F70-F79 Mental retardation
• F80-F89 Pervasive and specific developmental disorders
• F90-F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
• F99 Unspecified mental disorder

CHAPTER 6 - Diseases of the nervous system (G00-G99)

This chapter contains the following blocks:

• G00-G09 Inflammatory diseases of the central nervous system
• G10-G14 Systemic atrophies primarily affecting the central nervous system
• G20-G26 Extrapyramidal and movement disorders
• G30-G32 Other degenerative diseases of the nervous system
• G35-G37 Demyelinating diseases of the central nervous system
• G40-G47 Episodic and paroxysmal disorders
• G50-G59 Nerve, nerve root and plexus disorders
• G60-G64 Polyneuropathies and other disorders of the peripheral nervous system
• G70-G73 Diseases of myoneural junction and muscle
• G80-G83 Cerebral palsy and other paralytic syndromes
• G89-G99 Other disorders of the nervous system

CHAPTER 7 - Diseases of the eye and adnexa (H00-H59)

This chapter contains the following blocks:

• H00-H05 Disorders of eyelid, lacrimal system and orbit
• H10-H11 Disorders of conjunctiva
• H15-H22 Disorders of sclera, cornea, iris and ciliary body
• H25-H28 Disorders of lens
• H30-H36 Disorders of choroid and retina
• H40-H42 Glaucoma
• H43-H44 Disorders of vitreous body and globe
• H46-H47 Disorders of optic nerve and visual pathways
• H49-H52 Disorders of ocular muscles, binocular movement, accommodation and refraction
• H53-H54 Visual disturbances and blindness
• H55-H57 Other disorders of eye and adnexa
• H59 Intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified

CHAPTER 8 - Diseases of the ear and mastoid process (H60-H95)

This chapter contains the following blocks:

• H60-H62 Diseases of external ear
• H65-H75 Diseases of middle ear and mastoid
• H80-H83 Diseases of inner ear
• H90-H94 Other disorders of ear
• H95 Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified

CHAPTER 9 - Diseases of the circulatory system (I00-I99)

This chapter contains the following blocks:

• I00-I02Acute rheumatic fever
• I05-I09Chronic rheumatic heart diseases
• I10-I15Hypertensive diseases
• I20-I25Ischemic heart diseases
• I26-I28Pulmonary heart disease and diseases of pulmonary circulation
• I30-I52Other forms of heart disease
• I60-I69Cerebrovascular diseases
• I70-I79Diseases of arteries, arterioles and capillaries
• I80-I89Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified
• I95-I99Other and unspecified disorders of the circulatory system
• F70-F79 Mental retardation
• F80-F89 Pervasive and specific developmental disorders
• F90-F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
• F99 Unspecified mental disorder

CHAPTER 10 - Diseases of the respiratory system (J00-J99)

This chapter contains the following blocks:

• J00-J06 Acute upper respiratory infections
• J09-J18 Influenza and pneumonia
• J20-J22 Other acute lower respiratory infections
• J30-J39 Other diseases of upper respiratory tract
• J40-J47 Chronic lower respiratory diseases
• J60-J70 Lung diseases due to external agents
• J80-J84 Other respiratory diseases principally affecting the interstitium
• J85-J86 Suppurative and necrotic conditions of the lower respiratory tract
• J90-J94 Other diseases of the pleura
• J95 Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified
• J96-J99 Other diseases of the respiratory system

CHAPTER 11 - Diseases of the digestive system (K00-K93)

This chapter contains the following blocks:

• K00-K14 Diseases of oral cavity and salivary glands
• K20-K31 Diseases of esophagus, stomach and duodenum
• K35-K38 Diseases of appendix
• K40-K46 Hernia
• K50-K52 Noninfective enteritis and colitis
• K55-K63 Other diseases of intestines
• K65-K68 Diseases of peritoneum and retroperitoneum
• K70-K77 Diseases of liver
• K80-K87 Disorders of gallbladder, biliary tract and pancreas
• K90-K94 Other diseases of the digestive system

CHAPTER 12 - Diseases of the skin and subcutaneous tissue (L00-L99)

This chapter contains the following blocks:

• L00-L08 Infections of the skin and subcutaneous tissue
• L10-L14 Bullous disorders
• L20-L30 Dermatitis and eczema
• L40-L45 Papulosquamous disorders
• L49-L54 Urticaria and erythema
• L55-L59 Radiation-related disorders of the skin and subcutaneous tissue
• L60-L75 Disorders of skin appendages
• L76 Intraoperative and postprocedural complications of skin and subcutaneous tissue
• L80-L99 Other disorders of the skin and subcutaneous tissue

CHAPTER 13 - Diseases of the musculoskeletal system and connective tissue (M00-M99)=

This chapter contains the following blocks:

• M00-M02 Infectious arthropathies
• M05-M14 Inflammatory polyarthropathies
• M15-M19 Osteoarthritis
• M20-M25 Other joint disorders
• M26-M27 Dentofacial anomalies [including malocclusion] and other disorders of jaw
• M30-M36 Systemic connective tissue disorders
• M40-M43 Deforming dorsopathies
• M45-M49 Spondylopathies
• M50-M54 Other dorsopathies
• M60-M63 Disorders of muscles
• M65-M67 Disorders of synovium and tendon
• M70-M79 Other soft tissue disorders
• M80-M85 Disorders of bone density and structure
• M86-M90 Other osteopathies
• M91-M94 Chondropathies
• M95 Other disorders of the musculoskeletal system and connective tissue
• M96 Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified
• M99 Biomechanical lesions, not elsewhere classified

CHAPTER 14 - Diseases of the genitourinary system (N00-N99)

This chapter contains the following blocks:

• N00-N08 Glomerular diseases
• N10-N16 Renal tubulo-interstitial diseases
• N17-N19 Acute kidney failure and chronic kidney disease
• N20-N23 Urolithiasis
• N25-N29 Other disorders of kidney and ureter
• N30-N39 Other diseases of the urinary system
• N40-N51 Diseases of male genital organs
• N60-N65 Disorders of breast
• N70-N77 Inflammatory diseases of female pelvic organs
• N80-N98 Noninflammatory disorders of female genital tract
• N99 Intraoperative and postprocedural complications and disorders of genitourinary system, not elsewhere classified

CHAPTER 15 - Pregnancy, childbirth and the puerperium (O00-O99)

Note: CODES FROM THIS CHAPTER ARE FOR USE ONLY ON MATERNAL RECORDS, NEVER ON NEWBORN RECORDS This chapter contains the following blocks:

• O00-O08 Pregnancy with abortive outcome
• O09 Supervision of high risk pregnancy
• O10-O16 Edema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium
• O20-O29 Other maternal disorders predominantly related to pregnancy
• O30-O48 Maternal care related to the fetus and amniotic cavity and possible delivery problems
• O60-O77 Complications of labor and delivery
• O80, O82 Encounter for delivery
• O85-O92 Complications predominantly related to the puerperium
• O94-O9A Other obstetric conditions, not elsewhere classified

CHAPTER 16 - Certain conditions originating in the perinatal period (P00-P96)

NOTE: CODES FROM THIS CHAPTER ARE FOR USE ON NEWBORN RECORDS ONLY, NEVER ON MATERNAL RECORDS This chapter contains the following blocks:

• P00-P04 Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery
• P05-P08 Disorders related to length of gestation and fetal growth
• P09 Abnormal findings on neonatal screening
• P10-P15 Birth trauma
• P19-P29 Respiratory and cardiovascular disorders specific to the perinatal period
• P35-P39 Infections specific to the perinatal period
• P50-P61 Hemorrhagic and hematological disorders of newborn
• P70-P74 Transitory endocrine and metabolic disorders specific to newborn
• P76-P78 Digestive system disorders of newborn
• P80-P83 Conditions involving the integument and temperature regulation of newborn
• P84 Other problems with newborn
• P90-P96 Other disorders originating in the perinatal period

CHAPTER 17 - Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)

Note: CODES FROM THIS CHAPTER ARE NOT FOR USE ON MATERNAL OR FETAL RECORDS

• Q00-Q07 Congenital malformations of the nervous system
• Q10-Q18 Congenital malformations of eye, ear, face and neck
• Q20-Q28 Congenital malformations of the circulatory system
• Q30-Q34 Congenital malformations of the respiratory system
• Q35-Q37 Cleft lip and cleft palate
• Q38-Q45 Other congenital malformations of the digestive system
• Q50-Q56 Congenital malformations of genital organs
• Q60-Q64 Congenital malformations of the urinary system
• Q65-Q79 Congenital malformations and deformations of the musculoskeletal system
• Q80-Q89 Other congenital malformations
• Q90-Q99 Chromosomal abnormalities, not elsewhere classified

CHAPTER 18 - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

This chapter contains the following blocks:

• R00-R09 Symptoms and signs involving the circulatory and respiratory systems
• R10-R19 Symptoms and signs involving the digestive system and abdomen
• R20-R23 Symptoms and signs involving the skin and subcutaneous tissue
• R25-R29 Symptoms and signs involving the nervous and musculoskeletal systems
• R30-R39 Symptoms and signs involving the urinary system
• R40-R46 Symptoms and signs involving cognition, perception, emotional state and behavior
• R47-R49 Symptoms and signs involving speech and voice
• R50-R69 General symptoms and signs
• R70-R79 Abnormal findings on examination of blood, without diagnosis
• R80-R82 Abnormal findings on examination of urine, without diagnosis
• R83-R89 Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis
• R90-R94 Abnormal findings on diagnostic imaging and in function studies, without diagnosis
• R97 Abnormal tumor markers
• R99 Ill-defined and unknown cause of mortality

CHAPTER 19 - Injury, poisoning and certain other consequences of external causes (S00-T98)

This chapter contains the following blocks:

• S00-S09 Injuries to the head
• S10-S19 Injuries to the neck
• S20-S29 Injuries to the thorax
• S30-S39 Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals
• S40-S49 Injuries to the shoulder and upper arm
• S50-S59 Injuries to the elbow and forearm
• S60-S69 Injuries to the wrist and hand
• S70-S79 Injuries to the hip and thigh
• S80-S89 Injuries to the knee and lower leg
• S90-S99 Injuries to the ankle and foot
• T07 Unspecified multiple injuries
• T14 Injury of unspecified body region
• T15-T19 Effects of foreign body entering through natural orifice
• T20-T32 Burns and corrosions
• T33-T34 Frostbite
• T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
• T51-T65 Toxic effects of substances chiefly nonmedicinal as to source
• T66-T78 Other and unspecified effects of external causes
• T79 Certain early complications of trauma
• T80-T88 Complications of surgical and medical care, not elsewhere classified

CHAPTER 20 - External causes of morbidity (V01-Y99)

This chapter contains the following blocks:

• V00-X58 Accidents
• V00-V99 Transport accidents
• V00-V09 Pedestrian injured in transport accident
• V10-V19 Pedal cyclist injured in transport accident
• V20-V29 Motorcycle rider injured in transport accident
• V30-V39 Occupant of three-wheeled motor vehicle injured in transport accident
• V40-V49 Car occupant injured in transport accident
• V50-V59 Occupant of pick-up truck or van injured in transport accident
• V60-V69 Occupant of heavy transport vehicle injured in transport accident
• V70-V79 Bus occupant injured in transport accident
• V80-V89 Other land transport accidents
• V90-V94 Water transport accidents
• V95-V97 Air and space transport accidents
• V98-V99 Other and unspecified transport accidents
• W00-X58 Other external causes of accidental injury
• W00-W19 Slipping, tripping, stumbling and falls
• W20-W49 Exposure to inanimate mechanical forces
• W50-W64 Exposure to animate mechanical forces
• W65-W74 Accidental drowning and submersion
• W85-W99 Exposure to electric current, radiation and extreme ambient air temperature and pressure
• X00-X08 Exposure to smoke, fire and flames
• X10-X19 Contact with heat and hot substances
• X30-X39 Exposure to forces of nature
• X52, X58 Accidental exposure to other specified factors
• X71-X83 Intentional self-harm
• X92-Y08 Assault
• Y21-Y33 Event of undetermined intent
• Y35-Y38 Legal intervention, operations of war, military operations, and terrorism
• Y62-Y84 Complications of medical and surgical care
• Y62-Y69 Misadventures to patients during surgical and medical care
• Y70-Y82 Medical devices associated with adverse incidents in diagnostic and therapeutic use
• Y83-Y84 Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure
• Y90-Y99 Supplementary factors related to causes of morbidity classified elsewhere

CHAPTER 21 - Factors influencing health status and contact with health services (Z00-Z99)

This chapter contains the following blocks:

• Z00-Z13 Persons encountering health services for examination and investigation
• Z14-Z15 Genetic carrier and genetic susceptibility to disease
• Z16 Infection with drug resistant microorganisms
• Z17 Estrogen receptor status
• Z20-Z28 Persons with potential health hazards related to communicable diseases
• Z30-Z39 Persons encountering health services in circumstances related to reproduction
• Z40-Z53 Persons encountering health services for specific procedures and health care
• Z55-Z65 Persons with potential health hazards related to socioeconomic and psychosocial circumstances
• Z66 Do not resuscitate [DNR] status
• Z67 Blood type
• Z68 Body mass index (BMI)
• Z69-Z76 Persons encountering health services in other circumstances
• Z77-Z99 Persons with potential health hazards related to family and personal history and certain conditions influencing health status

7th Character

The appropriate 7th character is to be added to each code from category.

M1a

• 0 without tophus (tophi)
• 1 with tophus (tophi)

M48.4 - M48.5

• A initial encounter for fracture
• D subsequent encounter for fracture with routine healing
• G subsequent encounter for fracture with delayed healing
• S sequela of fracture

M80, M84.3 - M84.6

• A initial encounter for fracture
• D subsequent encounter for fracture with routine healing
• G subsequent encounter for fracture with delayed healing
• K subsequent encounter for fracture with nonunion
• P subsequent encounter for fracture with malunion
• S sequela

O31 - O32, O33.4 - O33.7, O35 - O41, O60.1 - O60.2, O64, O69,

7th character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies.

• 0 not applicable or unspecified
• 1 fetus 1
• 2 fetus 2
• 3 fetus 3
• 4 fetus 4
• 5 fetus 5
• 9 other fetus

R40.21, R40.22, R40.23

• 0 unspecified time
• 1 in the field [EMT or ambulance]
• 2 at arrival to emergency department
• 3 at hospital admission
• 4 24 hours or more after hospital admission

S00 - S78

• A initial encounter
• D subsequent encounter
• S sequela

S79.0, S79.1

A fracture not designated as open or closed should be coded to closed

• A initial encounter for closed fracture
• D subsequent encounter for fracture with routine healing
• G subsequent encounter for fracture with delayed healing
• K subsequent encounter for fracture with nonunion
• P subsequent encounter for fracture with malunion
• S sequela

S79.8, S79.9, S80 - S81, S83 - S88, S89.8, S89.9, S90 - S99

• A initial encounter
• D subsequent encounter
• S sequela

S82

A fracture not designated as open or closed should be coded to closed The open fracture designations are based on the Gustilo open fracture classification

• A initial encounter for closed fracture
• B initial encounter for open fracture type I or II initial encounter for open fracture NOS
• C initial encounter for open fracture type IIIA, IIIB, or IIIC
• D subsequent encounter for closed fracture with routine healing
• E subsequent encounter for open fracture type I or II with routine healing
• F subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
• G subsequent encounter for closed fracture with delayed healing
• H subsequent encounter for open fracture type I or II with delayed healing
• J subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
• K subsequent encounter for closed fracture with nonunion
• M subsequent encounter for open fracture type I or II with nonunion
• N subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
• P subsequent encounter for closed fracture with malunion
• Q subsequent encounter for open fracture type I or II with malunion
• R subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
• S sequela

S89.0, S89.1, S89.2, S89.3

A fracture not designated as open or closed should be coded to closed

• A initial encounter for closed fracture
• D subsequent encounter for fracture with routine healing
• G subsequent encounter for fracture with delayed healing
• K subsequent encounter for fracture with nonunion
• P subsequent encounter for fracture with malunion
• S sequela

T15 - T28, T33 - T85, T88

• A initial encounter
• D subsequent encounter
• S sequela

V00 - V99, W00 - W99, X00 - X99, Y00 - Y04, Y08 - Y38,

• A initial encounter
• D subsequent encounter
• S sequela

See also

• ICD-10 Procedure Coding System