Exclusions, Modifiers, and Comorbidities

Exclusions

Exclusion guidelines from WHO coding publications will be evaluated as a last step in mapping context evaluation.

Review of modifiers

There are two types of modifiers which appear in the ICD-10 Alphabetical Index: essential and non-essential.

Non-essential modifiers appear in parentheses following the terms they modify and do not affect the target code selection for a given condition, sign or symptom but are considered as alternatives to the expression of the term.

Non-essential modifiers appear in parentheses following the terms they modify and do not affect the target code selection for a given condition, sign or symptom but are considered as alternatives to the expression of the term.

Essential modifiers appear next to a lead term or as subterms indented below lead terms in the alphabetical index and do affect the selection of target code. They describe essential differences in site, etiology or type of disorder and must appear in the clinical statement for the code to be assigned.

The map specialist will review the ICD-10 Alphabetical Index to identify any essential modifiers which represent SNOMED CT concepts that are descendants of:

• the source concept to be mapped, or

• the source concept etiology SNOMED CT code when dagger and asterisk guidance requires a separate target for cause of the disorder. The Map Terminologist will add new Map members with the associated target specific to the alpha reference as context dependent maps with a mapRule.

Etiology and manifestation examples

Example 1

420485005 | Herpetic iridocyclitis (disorder)| maps to:

• B00.5† Herpes viral ocular disease

• H22.0* Iridocyclitis in infectious and parasitic diseases classified elsewhere

  THIS CODE MAY BE USED IN THE PRIMARY POSITION WHEN THE MANIFESTATION IS THE PRIMARY FOCUS OF CARE

Upon reviewing the WHO alphabetic index, the Map Terminologist notes the following codes:

Iridocyclitis -herpes, herpetic (simplex) B00.5† H22.0*

OR

Herpes, Herpetic -iridocyclitis (simplex) B00.5† H22.0*

Example 2

414924006 | Obstructed incisional ventral hernia (disorder)| maps to:

• K43.0 Ventral hernia with obstruction, without gangrene

Upon reviewing the WHO alphabetic index, the Map Terminologist notes Hernia, incisional has a reference to "see Hernia, ventral". To determine the target, the Map Terminologist follows the 'see' reference and checks under "Hernia, ventral". ICD-10 code K43.0 is listed under Hernia , ventral, with, obstruction. In addition, there are essential and nonessential modifiers to consider:

Hernia, hernial (acquired) (recurrent) K46.9 -incisional — see Hernia, ventral

Hernia, hernial (acquired) (recurrent) K46.9 -ventral K43.9 --with ---gangrene (and obstruction) K43.1 ---obstruction K43.0

Mapping for concepts of poisoning and overdose will require analysis of the Alphabetic Index's Table of Drugs and Chemicals. This table organizes drugs or chemicals along with the corresponding codes for adverse situations including accidental events, intentional self-harm, poisoning of undetermined intent, and adverse effects in therapeutic use. This table also may include essential modifiers which require attention for possible exclusion rules. For example, when mapping the SNOMED CT source concept 295830007 | Overdose of antidepressant drug (disorder)| a review of the drugs table will expose these entries for antidepressant poisoning:

Figure 1: Mapping Tool Index Viewer - Table of Drugs and Chemicals

In this case, the default target code for mapping of antidepressant poisoning is T43.2 for mapGroup one and X41 for mapGroup two based upon WHO advice to assume accidental poisoning when intent is unspecified. Note that essential modifiers are listed for MAO inhibitors, triazolpyridine, and tricyclic or tetracyclic antidepressants, which have potential to change the codes assigned.