EDITOR’S NOTE: This is the first in a two-part series.

There were very few changes to the ICD-10-CM Draft code set for 2013 – as was expected due to the partial code freeze that will be in effect through 2014.

Changes in the 2013 ICD-10-CM Draft code set primarily consisted of adding a few terms and correcting typos in the Alphabetic Index, and adding inclusion terms and correcting typos in the Tabular List. Even without significant changes to this year’s draft code set, however, there is updated information in the 2013 Official Guidelines for Coding and Reporting.

This information is as follows:

  • Coding conventions
    • Manifestation codes – Clarification given of manifestation codes that do not have “in diseases classified elsewhere” in the title
    • “And” – Example given for “and” meaning “and/or”
    • General coding guidelines
      • Laterality – Clarification given on use of unspecified side
      • Documentation – Depth of non-pressure ulcers specified
      • Syndromes – Reporting of additional codes for manifestations outlined
      • Borderline diagnosis – New guidelines given related to reporting conditions documented as “borderline”
      • Chapter 2 – Neoplasms
        • Malignant neoplasm of ectopic tissue – More detailed example added
        • Chapter 4 – Endocrine, Nutritional and Metabolic Diseases
          • Secondary Diabetes – Category E13 added to the list of categories for secondary diabetes
          • Chapter 9 – Diseases of the Circulatory System
            • Sequela of cerebrovascular disease – Additional clarification provided on reporting of nondominant/dominant side
            • Use of codes in category I69 – Sequela of cerebrovascular disease versus use of code for history of TIA or cerebral infarction clarified
            • Chapter 10 – Diseases of the Respiratory System
              • Influenza viruses – Clarification given of which influenza code category applies, based on physician documentation
              • Chapter 15 Pregnancy, Childbirth and the Puerperium
                • Termination of pregnancy – Clarification given on assignment and sequencing of codes when attempted termination results in live birth
                • Complications leading to abortion – Use of additional codes to identify complications given



Additional information is provided below on the more significant guideline and reporting clarifications and changes.

Etiology/Manifestation Codes

Due to an underlying etiology, certain conditions have manifestations that affect one or more body systems. ICD-10-CM coding conventions require that the underlying condition (etiology) code be sequenced first, followed by the manifestation code or codes. Whenever a condition requires etiology and manifestation codes, there is a “use additional code” note following the etiology code and a “code first” note following the manifestation code. These instructional notes are key to proper sequencing of the codes.

In most cases, the manifestation codes can be identified easily because the code titles include the descriptor “in diseases classified elsewhere.” The code title, along with the “use additional code” note, clearly identifies these codes as manifestation codes.

Codes that include “in diseases classified elsewhere” in the descriptor never are allowed to be the first-listed or principal diagnosis codes. Again, they must be used in conjunction with an underlying condition code, which is listed first.

Example: Dementia without behavioral disturbances in Parkinson’s disease

Etiology – G20 Parkinson’s disease

Manifestation – F02.80 Dementia in diseases classified elsewhere without behavioral disturbance

However, there are some manifestation codes that do not have “in diseases classified elsewhere” in the title. These codes do have a “use additional code” note following the etiology code and a “code first” note following the manifestation code, however.

The same sequencing rules apply, regardless of whether the manifestation code description includes the phrase “in diseases classified elsewhere.”

Example: Pseudobulbar affect due to multiple sclerosis

Etiology – G35 Multiple sclerosis

Manifestation – F48.2 Pseudobulbar affect (the first note following the code indicates that this condition is a manifestation and that it is sequenced after the underlying cause, which is multiple sclerosis.)


Even though few changes are expected to the ICD-10-CM Draft code set for the next few years, it is important to review the guidelines annually. Additional guidelines and reporting clarifications should be expected as more coders begin training under ICD-10-CM and requesting clarification related to code assignment and sequencing of codes.  In the next installment: Borderline Diagnosis and Influenza Codes.

About the Author

Lauri Gray, RHIT, CPC, has worked in the health information management field for 30 years. She began her career as a health records supervisor in a multi-specialty clinic. Following that she worked in the managed care industry as a contracting and coding specialist for a major HMO. Most recently she has worked as a clinical technical editor of coding and reimbursement print and electronic products. She has also taught medical coding at the College of Eastern Utah. Areas of expertise include: ICD-10-CM, ICD-10-PCS, ICD-9-CM diagnosis and procedure coding, physician coding and reimbursement, claims adjudication processes, third-party reimbursement, RBRVS and fee schedule development. She is a member of the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).

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