Medical Coding — ICD-10-CM Chapter Guidelines flashcards
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High-yield ICD-10-CM chapter rules: HIV, sepsis, neoplasms, diabetes, hypertension, MI timing, COPD, pregnancy and newborn coding, injuries and 7th characters, burns, poisoning versus adverse effect versus underdosing, external causes and Z codes (FY 2027).
Learn deck · part of Medical coding: AAPC CPC and AHIMA CCA · written against: ICD-10-CM Official Guidelines and code set FY 2027 (effective 1 October 2026); CPT structure and E/M guidelines described in our own words; HCPCS Level II, NCCI and ICD-10-PCS per CMS. Updated 2026-10-10.
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At discharge the provider documents "suspected HIV". Can HIV be coded on the inpatient record?No: only confirmed HIV is coded, an exception to the inpatient rule for uncertain diagnoses.ICD-10-CM Chapter Guidelines › Infectious Diseases
Confirmation needs no lab result in the record; the provider's statement that the patient is HIV positive or has an HIV-related illness is enough (Section I.C.1.a.1). -
A record says "HIV positive", and no symptoms or HIV-related illness have ever been documented. Which code applies?Z21, asymptomatic HIV infection status.ICD-10-CM Chapter Guidelines › Infectious Diseases
B20 is reserved for AIDS, HIV disease, or any HIV-related illness (Section I.C.1.a.2). -
A patient with AIDS is admitted for Pneumocystis pneumonia. What is the principal diagnosis?B20, HIV disease, followed by codes for the HIV-related conditions such as the pneumonia.ICD-10-CM Chapter Guidelines › Infectious Diseases
Watch out: when a patient with HIV disease is admitted for an unrelated problem, such as a fracture, that problem is principal and B20 is secondary. -
A patient had an HIV-related illness two years ago and is now symptom-free on antiretroviral therapy. Which HIV code is assigned?B20, because once an HIV-related illness has occurred, B20 is assigned at every later encounter.ICD-10-CM Chapter Guidelines › Infectious Diseases
Such a patient is never again coded to Z21 or R75 (Section I.C.1.a.2.g). -
A pregnant patient with symptomatic HIV disease is seen for prenatal care. Which code is sequenced first?A code from subcategory O98.7-, followed by B20 and codes for any HIV-related illness.ICD-10-CM Chapter Guidelines › Infectious Diseases
Chapter 15 codes take sequencing priority during pregnancy, childbirth and the puerperium (Section I.C.1.a.2.h). -
A provider documents "sepsis" with no organism named and no organ dysfunction. What is coded?A41.9, sepsis, unspecified organism.ICD-10-CM Chapter Guidelines › Infectious Diseases
A code from R65.2, severe sepsis, is added only when severe sepsis or an associated acute organ dysfunction is documented (Section I.C.1.d.1.a). -
What is the minimum set of codes for severe sepsis?The underlying systemic infection first, then a code from R65.2, plus codes for each associated acute organ dysfunction.ICD-10-CM Chapter Guidelines › Infectious Diseases
Use A41.9 for the infection when the causal organism is not documented (Section I.C.1.d.1.b). -
Can R65.21, severe sepsis with septic shock, ever be the principal diagnosis?No: the systemic infection is sequenced first, and septic shock is never principal.ICD-10-CM Chapter Guidelines › Infectious Diseases
Septic shock is treated as a form of acute organ dysfunction (Section I.C.1.d.2). -
A physician documents "urosepsis". How is it coded?Not until the provider is queried: urosepsis has no default code and is not a synonym for sepsis.ICD-10-CM Chapter Guidelines › Infectious Diseases
The provider must clarify whether the patient has a urinary tract infection, sepsis, or both (Section I.C.1.d.1.a). -
A patient is admitted with sepsis due to pneumonia, both present on admission. Which is principal?The sepsis (the systemic infection), with the pneumonia as a secondary diagnosis.ICD-10-CM Chapter Guidelines › Infectious Diseases
Watch out: if the patient is admitted with pneumonia and sepsis develops only after admission, the pneumonia is principal (Section I.C.1.d.4).
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Review status: Second-reader reviewed, with corrections applied.
Checked against:
- ICD-10-CM codes and rules checked against the ICD-10-CM Official Guidelines for Coding and Reporting FY 2027 and the FY 2027 code files (CDC/NCHS and CMS, effective 1 October 2026; public domain). Code sets change every 1 October; check the current year's books.
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