ICD-9-CM Coding Guidelines

Presented by Cheryl Crosswhite, CPC

Partial Freeze of Revisions:

October 1, 2011 – last major update of ICD-9-CM Annual update to ICD-9 is provided

online on the CDC website:

http://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm

ICD-9-CM Official Guidelines for Coding and Reporting

HIPAA regulations require

providers and third party payers to adhere to ICD-9-CM Official Guidelines for Coding and Reporting.

A violation of coding guidelines is a violation of HIPAA.

HIPAA Alert!

Four Sections:

- Section I- Section II- Section III

- Section IV

Official Guidelines for Coding & Reporting

Use both the ICD-9-CM Index to

Diseases and the Tabular List of Diseases.

Locate term in the Index to Diseases first, and verify the code in the Tabular List of Diseases.

Assign the highest level of digits available.

General Guidelines

Signs and symptoms that are

integral to the disease should not be assigned as additional codes.

The etiology and manifestation convention requires two codes to be reported to completely describe a single condition.

Guidelines

Multiple coding

- Use additional code- Code first- If applicable, code any causal

condition first Acute (or subacute) and chronic

conditions Combination code versus multiple

code

Guidelines

Residual condition that develops after

acute phase of illness or injury has ended

- No time limit on reporting

For example, traumatic arthritis (residual) following fracture of the left ankle three years ago (cause) (716.17, 905.4)

Combination code assigned, for example aphasia due to cerebrovascular accident 6 months ago (438.11)

Late Effect

Principal diagnosis Principal procedure Secondary diagnoses Secondary procedures First-listed diagnosis

Chapter-Specific Guidelines

001-139 Organisms Infections “Supplemental Classification of

Factors Influencing Health Status and Contact with Health Services”

Human immunodeficiency virus (HIV)

Chapter 1: Infectious and Parasitic Diseases

Key terms:

- HIV disease- HIV infection- HIV infected- HIV positive- Acquired immune deficiency syndrome

(AIDS)

HIV Positive Status

140-239 Neoplasm

- “New growths or tumors in which cell reproduction is out of control”

Benign Malignant

Chapter 2: Neoplasms

Six classifications:

- Primary malignancy- Secondary malignancy- Carcinoma (CA) in situ- Benign- Uncertain behavior- Unspecified nature

Chapter 2: Neoplasms

Contiguous sites (overlapping

sites) Re-excision of tumors

Chapter 2: Neoplasms

240-279 Diabetes mellitus

- Type I: Patient’s body unable to produce insulin

- Type II:Patient’s body unable to properly use

insulin produced

Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity

Disorders

280-289 Hematopoiesis Anemia Red cell volume Hemoglobin content Shape (morphology) Purpura

Chapter 4: Diseases of the Blood and Blood-Forming Organs

290-319 WHO guidelines:

- When classifying behavioral disorders, organically based illnesses are reported before functional illnesses.

- Within a functional group, classify disorders as psychoses, neuroses, personality disorders, and others.

Chapter 5: Mental Disorders

WHO Guidelines:

- When coding mental illnesses associated with physical conditions, assign as many codes as necessary to fully describe the clinical picture.

Chapter 5: Mental Disorders

320-389 Nervous system, including

meninges Central nervous system

- Brain- Spinal cord

Peripheral nervous system

Chapter 6: Nervous System and Sense Organs

390-459 Hypertension, hypertensive table

- Malignant (accelerated)- Benign- Unspecified

Cerebral infarction, stroke, CVA Late effects of cerebrovascular disease Myocardial infarction

Chapter 7: Circulatory System

460-519 Nose, sinuses, pharynx, larynx, trachea,

bronchi, and lungs Chronic obstructive pulmonary disease

- Refer to main term “obstruction” Pneumonia Asthma (status asthmaticus) Acute exacerbation

Chapter 8: Respiratory System

520-579 Major digestive organs include

pharynx, esophagus, stomach, and intestines

Accessory (secondary) organs include salivary and parotid glands, jaw, and teeth

Structures that support the digestive process are gallbladder, pancreas, and liver

Chapter 9: Digestive System

580-629 Chronic kidney disease (CKD) Kidney transplant status

(V42.0) CKD with other conditions

Chapter 10: Genitourinary System

630-677 Conditions occurring during

pregnancy, childbirth, and six weeks immediately following childbirth

Never report these codes on baby’s record

Outcome of delivery (V27.0-V27.9

Chapter 11: Pregnancy, Childbirth, and Puerperium

630-633 (ectopic or molar

pregnancy) 639 (complications following

abortion and ectopic or molar pregnancy)

Fifth digits to identify abortive stage

- Unspecified (0)- Incomplete (1)- Complete (2)

Chapter 11: Pregnancy, Childbirth, and Puerperium

640-648 (complications related to

pregnancy) 650 (normal delivery)

- Minimal or no assistance- Episiotomy permitted- Fetal manipulation (e.g., use of

forceps) not permitted

Chapter 11: Pregnancy, Childbirth, and Puerperium

Fifth digit required for current episode of care

- Unspecified as to episode of care (0)- Delivered with or without mention of antepartum condition (1)- Delivered with mention of postpartum

complication (2)- Antepartum condition or complication (3)- Postpartum condition or complication (4)

Chapter 11: Pregnancy, Childbirth, and Puerperium

680-709 Epidermis, dermis, subcutaneous

tissue, nails, sebaceous glands, sweat glands, hair, and hair follicles

Chapter 12: Skin and Subcutaneous Tissue

710-739 Bones, muscles, cartilage, fascia, ligaments,

synovia, tendons, and bursa Localized osteoarthrosis

- Primary, unknown etiology- Secondary, caused by external or internal

injury

Chapter 13: Musculoskeletal System and Connective Tissue

740-759 Classifies all conditions according to a

principal or defining defect rather than cause

- Except for chromosome abnormalities May be apparent at birth or hidden and

identified sometime after birth Codes may be used throughout

patient’s life

Chapter 14: Congenital Anomalies

760-779 Perinatal period

- Interval of time before, during, and up to 28 days following birth NEVER report these codes for the

mother’s episode of care

Chapter 15: Conditions Originating in Perinatal Period

780-799 Includes symptoms, signs and

abnormal results of laboratory or other investigative procedures

Chapter 16: Symptoms, Signs, Ill-Defined Conditions

Key terms:

- Abnormal, abnormality- Decrease, decreased- Elevation- Findings, abnormal, without

diagnosis

Chapter 16: Symptoms, Signs, Ill-Defined Conditions

800-999 Injuries Fractures Burns Adverse effects, poisonings, and

toxic effects

Chapter 17: Injury and Poisoning

Open/Compound fracture Closed/Simple fracture

- Comminuted- Depressed- Fissured- Greenstick- Impacted

Fractures

Closed/Simple fracture

- Linear- Slipped epiphysis- Spiral fracture

Complicated Malunion (late effect)

Fractures

940-949 Classified according to:

- Depth First degree (erythema) Second degree (blistering) Third degree (full thickness)

- Extent Percentage of body surface

- Agent (e.g., chemicals, fire, sun) E Codes assigned

Burns

Adverse effect (adverse reaction)

- Appearance of pathologic condition caused by ingestion or exposure to chemical substance

properly administered or taken- For example, allergic rash due to

penicillin- Table of Drugs and Chemicals

Adverse Effects, Poisonings, and Toxic

Effects

Occurs as result of overdose

Wrong substance administered or taken or intoxication that involves combining prescribed drugs with non-prescribed drugs or alcohol

For example, coma due to overdose of codeine

Poisoning

960-979 Manifestation of poisoning Accidental (E850-E869) Suicide attempt (E950-E952) Assault (E961-E962) Undetermined (E980-E982)

Poisoning

When someone ingests or

comes into contact with a harmful substance

Toxic Effects

V01-V85 Supplementary Classification of Factors

Influencing Health Status and contact with Health Services

Classifies occasions when circumstances other than disease or injury are recorded as diagnoses or problems

V Codes

Categories:

- Contact/Exposure- Inoculations and vaccinations- Status- History (of)- Screening- Observation- Aftercare

V Codes

Categories, cont.

- Follow-up- Donor- Counseling- Obstetrics and related conditions- Newborn, infant, and child- Routine and administrative examinations- Miscellaneous

V Codes

E800-E999 Supplemental Classification of

External Causes of Injury and Poisoning

Classifies environmental events, circumstances, and conditions as cause of injury, poisoning, or other adverse effect

E Codes

Reported in addition to a code

from Chapters 1-17 to indicate nature of condition

Machinery accidents (E919) Late effects of accidents (E929,

E959, E969, E977, E989, E999) Transport accidents (E800-E848)

E Codes

Place of occurrence (E849)

- Describes place where event occurred, NOT patient’s

activity at the time

E Codes