Using ICD-9-CM

1. Using ICD-9-CM Chapter 4

2. Using ICD-9-CM Chapter 11, Complications of Childbirth, and Puerperium Chapter 12, Diseases of Skin and Subcutaneous Tissue Chapter 13, Diseases of Musculoskeletal System and Connective Tissue Chapters Congenital Anomalies;14 and 15, Certain Conditions Originating in Perinatal Period Chapter 16, Symptoms, Signs, and Ill-Defined Conditions Chapter 17, Injury and Poisonings and E Codes Basic Coding Guidelines ICD-10-CM General Guidelines Chapter 1, Infectious and Parasitic Diseases Chapter 2, Neoplasms Chapter 3, Endocrine, Nutritional, and Metabolic Diseases, and Immunity Disorders Chapter 4, Diseases of Blood and Blood- Forming Organs Chapter 5, Mental Disorders Chapter 6, Diseases of Nervous System and Sense Organs Chapter 7, Diseases of Circulatory System Chapter 8, Diseases of Respiratory System Chapter 9, Diseases of Digestive System Chapter 10, Diseases of Genitourinary System

3. Steps to Accurate Coding • Identify MAIN term(s) in diagnosis • Locate MAIN term(s) in Index • Review subterms • Follow cross-reference instructions • (e.g., see, see also) • Verify code(s) in Tabular

4. Remember • Read Tabular notes • Code to highest specificity (detail) • NEVER CODE FROM INDEX!

5. Guideline Section I.B.7. Conditions integral to disease • Signs and symptoms that are associated routinely with a disease processshould not be reported separately, unless otherwise instructed in the classification • Example: • Fever and shortness of breath due to pneumonia • Report only Pneumonia 486

6. Guideline Section I.B.8. Conditions NOT integral to disease • Additional signs and symptoms not routinely associated with disease process should be reported • Example: • Dehydration due to pneumonia • Report • Pneumonia and • dehydration

7. Section I.B.9. Multiple coding for a single condition • Etiology (cause) • Manifestation (symptom) • Slanted brackets [ ] • Example: Retinopathy, diabetic 250.5 [362.01] • Code as shown • 250.5X • 362.01 (Cont’d…)

8. Section I.B.9. Multiple coding for a single condition (…Cont’d) • Must check Tabular notes to assign correct fifth digit for diabetes • Tabular: 362.0, Diabetic retinopathy, instructs to “Code first diabetes 250.5” • 250.5X Cause is diabetes • 362.01 Manifestation is retinopathy • Report 250.5X, 362.01 • X = required additional digit

9. Section I.B.10. Acute and Chronic Conditions • Exists alone or together • May be separate or combo codes • Reporting both codes, code acute first (Cont’d…)

10. Section I.B.10. Acute and Chronic Conditions (…Cont’d) • Example, acute and chronic pancreatitis • When two separate codes exist, code: • Acute pancreatitis 577.0 • Chronic pancreatitis 577.1 • Place acute first and chronic second • 577.0, 577.1 (Cont’d…)

11. Section I.B.11. Combination Code • Always use combination code if one exists • Example, encephalomyelitis (manifestation) due to rubella (etiology), 056.01 • Assign only when code fully identifies condition

12. Section I.B.12. Late Effects • Ex., 701.4 followed by code 906.6 • Late effect is a residual of(remaining from) previous illness/injury • e.g., Scar produced by previous burn • Residual coded first (scar) • Late effect cause (burn) coded second906.6 • No time limit • Generally requires 2 codes (Cont’d…)

13. ICD-9-CM CODING Conclusion – General Guidelines