Cracking the Code

Coding Impending Conditions

CMS has outlined in the ICD-10-CM guidelines how to code documentation when there is an impending or threatened diagnosis. The I.B.11 guideline states, “Code any condition described at the time of discharge as “impending” or “threatened” as follows: If it did occur, code as a confirmed diagnosis. If it did not occur, reference the Alphabetic Index to determine if the condition has a subentry term for “impending” or “threatened” and also reference main term entries for “Impending” and for “Threatened.” If the sub-terms are listed, assign the given code. If the sub-terms are not listed, code the existing underlying condition(s) and not the condition described as impending or threatened.”


To recap, when a patient is discharged with a condition documented as “impending” or “threatened”, you will want to make sure that you review the ICD-10-CM Alphabetic Index for the sub-term ‘impending’ or ‘threatened’ under the main term of the condition.


If a sub-term does not exist, reference ‘Impending or Threatened’ as the main term, with the condition as a sub-term.


If a suitable code does not exist, report the signs and symptoms that led the provider to suspect an impending or threatened condition.

Q: What is the appropriate action when a physician documents an impending condition that had not occurred by the time of discharge?
A: Review the ICD-10-CM Alphabetic Index to see if there are listings under threatened or impending; and if not, code the existing underlying condition/conditions rather than the condition described as impending. Rationale: ICD-10-CM Official Guidelines for Coding and Reporting, section I.B.11, tells us to check the Alphabetic Index for listings under threatened or impending; and if not, we are to code the existing underlying condition/conditions, not the condition described as impending.
Reference: FY 2023 ICD-10-CM code book & guidelines
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