In this new series of articles, we will look at chapter 18 in ICD-10-CM representing Symptoms, Signs, and Abnormal Clinical Findings, Not Otherwise Specified. In ICD-9-CM, we are currently using Chapter 16 codes for Symptoms, Signs, and Ill-Defined Conditions.
One significant area of use for this particular chapter of codes is the Emergency Department. Emergency physicians often are presented with the signs and symptoms that may not translate into a definitive diagnosis during that visit. Resulting inpatient admissions and referrals are usually necessary to do further testing of provisional diagnoses. The codes we will be examining in this series cover many of the ED diagnoses.
The first noticeable difference is that in ICD-9-CM, only three sections represent the entire chapter of codes; however, in ICD-10-CM, there is an expansion of the chapter to contain what are now referred to as blocks. In place of sections, there are seven code blocks that identify symptoms and signs for specific body systems, followed by a code block for general symptoms and signs. In addition to those eight blocks, five more blocks are used for reporting abnormal findings for laboratory tests, imaging and function studies, and finally, tumor markers.
Below is a table that illustrates the comparison of ICD-9-CM and ICD-10-CM.
| ICD-9-CM SECTIONS | ICD-10-CM BLOCKS |
| 780-789 Symptoms
790-796 Nonspecific Abnormal Findings 797-799 Ill-defined and Unknown Causes of Morbidity and Mortality |
R00-R09; Symptoms and Signs involving the Circulatory and Respiratory Symptoms
R10-R19 Symptoms and Signs involving the Digestive System and Abdomen R20-R23 Symptoms and Signs involving the Skin and Subcutaneous Tissue R25-F29 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 |
The new structure offers an enormous improvement in content and logic, and this is what really intrigues and excites us about the implementation of ICD-10-CM. We can now classify and code to the greatest specificity, in a logical manner, allowing for better tracking of data concerning all diagnoses. Virtually all categories in Chapter 18 could be designated as ‘not otherwise specified,’ ‘unknown etiology,’ or ‘transient.’ The residual subcategories ending in .8 are provided for those relevant systems that cannot be distributed elsewhere in the classification.
According to the 2012 ICD-10-CM draft, all clinical conditions and signs or symptoms included in R00-R94 will represent the following criteria:
- Cases for which no more specific diagnosis can be made even after all the facts bearing on the case have been investigated;
- Signs or symptoms existing at the same time of initial encounter that proved to be transient and whose causes could not be determined;
- Cases referred to elsewhere for investigation or treatment before the diagnosis was made;
- Cases in which a more precise diagnosis was not available for any other reason;
- Certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right.
Continue to follow this new series focusing on the ICD-10-CM, Chapter 18 codes for Symptoms, Signs and Abnormal Clinical Findings, Not elsewhere classified (R00-R99). As we delve into the guidelines, in the next article, we will gain a clear understanding of when coding from Chapter 18 is appropriate.
For more ICD-10 articles, please visit our ICD-10 Updates page.
— Compiled by former CIPROMS ICD-10 Coordinator, Angela Hickman, CPC, CEDC, AHIMA-Approved ICD-10 CM/PCS Trainer, AHIMA Ambassador. All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com.
