Chapter 6 ICD-9-CM Coding

ICD-9-CM Coding• International Classification of Diseases

(ICD)– Used to code and classify mortality (death) data from

death certificates

• International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)– Used to code and classify morbidity (disease) data

from inpatient and outpatient records

ICD-10-CM/PCS• Will replace ICD-9 CM on October 1, 2013

– More codes

– Enhances accurate payment of services

– Incorporates much greater specificity and clinical information

– See file

ICD-9-CM Tabular List of Diseases

• Must be used to identify diagnoses, symptoms, conditions, problems, complaints, or any other reason for the encounter/visit

• Codes that describe signs and symptoms are acceptable for reporting purposes when the physician has not documented an established or confirmed diagnosis

Level of Detail in Coding• Codes contain three, four, or five digits

• Codes with three digits:– Included in ICD-9-CM as the heading of a category of

disease codes

– Maybe further subdivided into four or five digits• Provide greater specificity

Sequencing ICD-9-CM Diagnosis

• First code for the diagnosis, condition, problem, or other reason for encounter shown in the medical record to be chiefly responsible for the services provided

• Additional codes that describe coexisting conditions that were treated or medically managed during the encounter should also be reported

Encounter for Services

Diagnostic Services

• First, report the diagnosis, condition, problem, or reason for encounter that is documented in the patient record as being chiefly responsible for the outpatient services provided during the encounter.

Therapeutic Services

• Sequence first the diagnosis,condition, problem, or otherreason for the encounter shown in the medical recordto be chiefly responsible forthe outpatient services pro-vided.

• Assign code(s) to other diagnoses (e.g., chronic conditions) that are treated or medically managed or would affect thepatient’s receipt of services .

Supplementary Classifications:V Codes and E Codes

• V codes are assigned when a circumstance other than a disease or injury is present.

• V codes provide codes to deal with encounters for circumstances other than a disease or injury

• Like V codes, E codes are located in the Tabular List: – E codes describe external causes of injury, like poisoning,

accidents, or other adverse reactions affecting a patient’s health.

•

Appendices• Appendices serve in coding neoplasms,

adverse effects of chemicals and drugs, and external causes of disease and injury.

• In addition, the disease category codes are listed as an appendix.

• Classification of industrial accidents according to agency based on employment injury statistics

Index to Diseases

• Step 1– Locate main term in the Index to Diseases

• Step 2– If the phrase “see condition” is found after the main

term look at the descriptive term

• Step 3– When the condition listed cannot be found locate main

terms such as syndrome, disease, disorder

Coding conventions – rules that apply to the assignment of ICD-9-

CM codes– Codes in slanted

brackets

– Eponyms

– Essential modifiers

– NEC

– Nonessential modifiers

– Notes

– See

– See also

– See also condition

Using the Tabular List

• After reviewing main terms and subterms– Locate the first possible code in the Index to Disease.

• In the Tabular List– Locate code, review code descriptions, review any

EXCLUDES notes to determine whether the condition being coded is excluded.

• Assign any required fifth digit

Index to Procedures and Tabular List of Procedures

• Principal Procedures– A procedure performed for definitive treatment rather

than diagnostic purpose

– One performed to treat a complication

– One that is most closely related to principal diagnosis

• Secondary Procedures– Additional procedures performed during same

encounter as the principal procedure

Hypertension/Hypertensive Table

• Malignant– Severe form of hypertension with vascular damage and

a diastolic pressure reading of 130 mmHg or greater

• Benign– Mild or controlled hypertension

• Unspecified– No notation of benign or malignant status

Neoplasm Table

• Neoplasms

• Another term related with neoplasm is lesion

• Primary Malignancy

• Secondary Malignancy

• Carcinoma (Ca) in situ

• TIP: other terms to consider are mass, cyst, dysplasia, polyp, adenosis

Table of Drugs and Chemicals• Poisonings occur as a result of an overdose,

wrong substance administered or taken, or intoxication.

• Six columns in the table:– Poisoning

– Accident

– Therapeutic use

– Suicide attempt

– Assault

– Undetermined

Supplementary Classifications• ICD-9-CM contains two supplementary

classifications:– V codes

• Factors influencing health status and contact with health services

– E codes • External causes of injury and poisoning

E Codes• Used to describe the circumstances of an

illness or injury

• Many states require their use; insurance companies do not

• Can expedite claims payment

• NEVER use as a first-listed diagnosis on a claim