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CHAPTER 11

CHAPTER 11. CHAPTER-SPECIFIC GUIDELINES (ICD-9-CM CHAPTERS 1-8). ICD-9-CM, Chapter 1. Infectious and Parasitic Diseases Divided based on etiology (cause of disease) Many combination codes Example: 112.0 candidiasis infection of mouth, which reports both organism and condition with one code.

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CHAPTER 11

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  1. CHAPTER 11 CHAPTER-SPECIFIC GUIDELINES (ICD-9-CM CHAPTERS 1-8)

  2. ICD-9-CM, Chapter 1 • Infectious and Parasitic Diseases • Divided based on etiology(cause of disease) • Many combination codes • Example: 112.0 candidiasis infection of mouth, which reports both organism and condition with one code

  3. Multiple Codes • Sequencing must be considered • UTI due to Escherichia coli • 599.0 (UTI) etiology • 041.4X (E. coli) organism • 041 category is a secondary-code only

  4. Section I.C.1.a,d,e Human Immunodeficiency Virus • Code HIV or HIV-related illness ONLY if stated as confirmed in diagnostic statement • 042 HIV or HIV-related illness • V08 Asymptomatic HIV status • 795.71 Nonspecific HIV serology • Once an HIV diagnosis cannot code V08

  5. Section I.C.1.a.2.f. Previously diagnosed HIV-related illness • Code prior diagnosis HIV-related disease 042 (HIV) • NEVER assign these patients to: • V08 (asymptomatic) or • 795.71 (Nonspecific serologic evidence of HIV)

  6. Section I.C.1.a.2. Selection and sequencing of HIV codes • If admitted for HIV-related illness (e.g., pneumonia) • Code 042 (HIV) • Followed by current illness (pneumocystic carinii, 136.3) • If admitted for other than HIV-related illness • Code first-listed diagnosis • Then 042 (HIV) (Cont’d…)

  7. Section I.C.1.a.2. Selection and sequencing of HIV codes (…Cont’d) • Sequence • Reason most responsible for encounter, if HIV (042) • Any additional diagnosis that impacts treatment

  8. Section I.C.1.a.2.g. HIV infection in Pregnancy, Childbirth and the Puerperium • Exception to HIV sequencing • During pregnancy, childbirth, or puerperium, code: • 647.6X (Other specified infections and parasitic diseases) • Followed by 042 (HIV) (stated diagnosis) • Then any HIV-related illness (Cont’d…)

  9. Section I.C.1.a.2.g. HIV and Pregnancy (…Cont’d) • Asymptomatic HIV during pregnancy, childbirth, or puerperium • 647.6X (Other specified infections and parasitic diseases) and • V08 (Asymptomatic HIV infection status)

  10. Section I.C.1.a.2.e. Patients with inconclusive HIV serology • 795.71 (Inconclusive serologic test for HIV)

  11. Section I.C.1.a.2.h. Encounters for testing for HIV • Code V73.89 (Screening for other specified viral disease) • Patient in high-risk group for HIV • V69.5 (Other problems related to lifestyle) • Patients returning for HIV screening results = V65.44 (HIV counseling)

  12. Caution • Incorrectly applying these HIV coding rules can cause patient hardship • Insurance claims for patients with HIV usually need patient’s written agreement to disclose

  13. Section I.C.1.b. Septicemia, Septic Shock and SIRS • Septicemia: systemic disease of microorganisms or their toxins in the blood (blood poisoning) • Septic shock: cardiovascular failure due to sepsis • SIRS: Systemic Inflammatory Response Syndrome is a systemic response to infection/trauma • Sepsis refers to SIRS due to infection • Severe sepsis is sepsis with acute organ dysfunction (Cont’d…)

  14. Section I.C.1.b. Septicemia, Septic Shock and SIRS (…Cont’d) • Code septicemia (038.XX) • SIRS second (995.9X) • If documented, septic shock (785.52) should be reported • Sepsis and septic shock associated with OB codes, also use code 630-633, Ectopic and Molar Pregnancy • Septic shock is never primary or first-listed diagnosis

  15. Sepsis and Severe Sepsis not associated with noninfectious process • Infection resulting from Trauma, Other Serious Injury, Pancreatitis • Code Trauma/Injury • SIRS second (995.9X) • Any acute organ dysfunctions • When sepsis or severe sepsis is PDx, sequence systemic infection & sepsis codes before non-infectious condition

  16. ICD-9-CM, Chapter 2 Neoplasm • Two steps for coding neoplasms: • Index: Locate histologic type of neoplasm (e.g., sarcoma, melanoma) • Review all instructions • Locate code identified (usually in Neoplasm Table in Index) by body site • Neoplasms Table divided into columns: • Malignant (primary, secondary, Ca in situ) • Benign • Uncertain behavior • Unspecified

  17. ICD-9-CM, Chapter 2 Neoplasm Morphology Codes-Appendix A ICD-9-CM • Codes are alpha numeric: M + 4 numeric characters, a slash, followed by 5th digit (indicates behavior) • Assigned by tumor registry coder /0= Benign /1= Uncertain benign/malignant/borderline /2=Carcinoma in situ /3= Malignant, primary site /6= Malignant, secondary/metastatic site /9= Malignant, uncertain if primary/secondary site • Not assigned in outpatient setting

  18. Section I.C.2. Neoplasms • Treatment directed at malignancy: Neoplasm is first-listed diagnosis • Except for chemotherapy or radiotherapy: • Therapy (treatment) • Neoplasm • Chemotherapy: V58.11—encounter for reason the patient presents for treatment, #1 diagnosis • Radiotherapy: V58.0—encounter for reason the patient presents for treatment, #1 diagnosis (Cont’d…)

  19. Section I.C.2. Neoplasms (…Cont’d) • Surgical removal of neoplasm and subsequent chemotherapy or radiotherapy • Code malignancy as first-listed diagnosis • Surgery to determine extent of malignancy • Code malignancy as first-listed diagnosis • Code neoplasm as long as patient is receiving treatment or medication following excision (Cont’d…)

  20. Section I.C.2. Neoplasms (…Cont’d) • V10, “Personal history of malignant neoplasm” if • Neoplasm was previously destroyed/removed • No longer being treated (Cont’d…)

  21. Section I.C.2. Neoplasms (…Cont’d) • If patient receives treatment for secondary neoplasm (metastasis): • Secondary neoplasm is first-listed diagnosis • Even though primary is known • Code primary neoplasm as secondary diagnosis or if no longer treated code personal history of... (Cont’d…)

  22. Section I.C.2. Neoplasms (…Cont’d) • Admission for symptoms of primary or secondary neoplasm • Malignancy first-listed diagnosis • Do NOT code symptoms or signs • First-listed is site receiving treatment • If both primary and mets are treated, code primary as first-listed (Cont’d…)

  23. Section I.C.2. Neoplasms (…Cont’d) • Patient treated for anemia or dehydration due to neoplasm or therapy • Code • Anemia or dehydration • Neoplasm • Patient admitted for pain control due to neoplasm, 338.3 (Cont’d…)

  24. Section I.C.2. Neoplasms (…Cont’d) • Patient admitted to repair complication of surgery for an intestinal malignancy • Complication first-listed diagnosis • Complication is reason for encounter • Malignancy secondary diagnosis (Cont’d…)

  25. V Codes and Neoplasms • Patient receiving chemotherapy or radiotherapy post-op removal of neoplasm • Code: • Therapy • Active neoplasm still being treated • Do NOT report H/O (history of) neoplasm

  26. ICD-9-CM, Chapter 3 • Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders

  27. Disorders of Other Endocrine Glands • Diabetes Mellitus 250 coded frequently • Subterms often have two codes • Example: • Diabetic iritis 250.5X for diabetes (etiology) • [364.42] for iritis (manifestation) • Metabolic manifestation only one code assignment, e.g., diabetic ketoacidosis (250.1X) (Cont’d…)

  28. Disorders of Other Endocrine Glands (…Cont’d) • Fifth digit indicates type of diabetes • Adult or juvenile 0, 2: Type II • 0 Type II or unspecified type, not stated as uncontrolled • 2 Type II or unspecified type uncontrolled 1, 3: Type I • 1 Juvenile type, not stated as uncontrolled • 3 Juvenile type, uncontrolled (Cont’d…)

  29. Disorders of Other Endocrine Glands ( …Cont’d) • Type I—Insulin dependent—pancreas does not produce insulin • Type II—non-insulin dependent—(can be on insulin) • “Uncontrolled”—must be documented by physician • Can use “out of control” • Cannot assign “uncontrolled” status when documentation states “poorly controlled” (Cont’d…)

  30. Disorders of Other Endocrine Glands (…Cont’d) • V58.67 in addition to diabetes code to indicate long-term use of insulin • If type is not indicated, code Type II diabetes • Patient with Type II diabetes can receive insulin • Type I diabetic is insulin dependent

  31. Other Metabolic and Immunity Disorders Section • Disorders such as gout and dehydration • Disorders often have many names • 242.0X Toxic diffuse goiter also known as: • Basedow’s disease • Graves’ disease • Primary thyroid hyperplasia

  32. ICD-9-CM, Chapter 4 • Diseases of Blood and Blood-Forming Organs • Short chapter with 10 sections • Includes anemia, blood disorders, coagulation defects (Cont’d…)

  33. Chapter 4 (…Cont’d) • Often used code, anemia • Many different types of anemia: • Hereditary hemolytic (282) • Iron deficiency (280) • Acquired hemolytic (283) • Multiple coding often necessary • Identify underlying disease condition (Cont’d…)

  34. Chapter 4 (…Cont’d) Two confusing anemias: • anemia of chronic disease • disease causing anemia is chronic • Code 285.2X and then the appropriate code for the chronic disease • chronic simple anemia • Anemia (285.9), chronic simple (281.9)

  35. ICD-9-CM, Chapter 5, Mental, Behaviorial and Neurodevelopmental Disorders • Includes codes for • Personality disorders • Stress disorders • Neuroses • Psychoses • Sexual deviation/dysfunction, etc. • Intellectual disabilities (Cont’d…)

  36. Chapter 5 (…Cont’d) • Fifth digit = status of episode • Example: 304, Drug dependence has following fifth digits: 0: unspecified (episode) 1: continuous 2: episodic 3: in remission

  37. ICD-9-CM, Chapter 6 • Diseases of Nervous System and Sense Organs • Central Nervous System • Peripheral Nervous System • Disorders of Eye and Adnexa • Diseases of Ear and Mastoid Process

  38. Pain not elsewhere classified (338) • Acute or chronic pain due to: • Trauma • Postoperative • Neoplasm • Psychosocial dysfunction • NOT for generalized or localized pain • First-listed/primary diagnosis • When definitive diagnosis not established • Pain management is reason for encounter/admission

  39. ICD-9-CM, Chapter 7—Diseases of Circulatory System • Three types of hypertension: • Malignant—accelerated • Benign—continuous, mild (BP↑) controllable, no irreversible vascular changes • Unspecified—NOT indicated as either malignant or benign (.9) • Hypertension table located in Indexof ICD-9-CM • Under “H,” Hypertension • Locate now

  40. Section I.C.7.a.1. Hypertension, Essential, or NOS • Assign hypertension • arterial • essential • primary • systemic • NOS to 401 • Fourth digit to indicate type, 401.X

  41. Section I.C.7.a.2. Hypertension with Heart Disease • 402 Category • Certain heart conditions when stated “due to hypertension” or implied (“hypertensive”) • Add fourth digit for type • Use additional code to specify type of heart failure (428)

  42. Section I.C.7.a.3. Hypertensive Chronic Kidney Disease • Cause-and-effect relationship assumed in chronic kidney disease with hypertension • Category 403, Hypertensive chronic kidney disease, used when: • Category 585 or code 587 are present with hypertension • With 403 assign fifth digit 0 stage I-IV or unspecified and 1 for stage V or end stage renal disease

  43. Section I.C.7.a.4. Hypertensive Heart and Chronic Kidney Disease • Assign 404 when both hypertensive chronic kidney disease and hypertensive heart disease stated • Assume cause-and-effect relationship • Assign fifth digit for mention of heart failure, and/or kidney failure stages I-IV or end stage renal disease • Use additional code from category 428, identifying type of heart disease

  44. Stages of Chronic Kidney Disease • Stage I: Blood flow through kidney increases, kidney enlarges (585.1) • Stage II: (mild) Small amounts of blood protein (albumin) leaks into urine (microalbuminuria) (585.2) • Stage III: (moderate) Albumin and other protein losses increase. Patient may develop high BP and kidney’s filter ability (585.3) • Stage IV: (severe) Large amounts of urine pass through kidney, blood pressure increases (585.4) • Stage V: Ability to filter waste nearly stops (585.5) • End stage renal failure (585.6) • When documentation indicates chronic renal disease (CKD) and ESRD, report ESRD • Unspecified 585.9

  45. Section I.C.7.a.5. Hypertensive Cerebrovascular Disease Code: • Cerebrovascular disease (430-438) first • Type of hypertension (401-405) second

  46. Section I.C.7.a.6. Hypertensive Retinopathy Code: • Hypertensive retinopathy first (362.11) • Type of hypertension (401-405) second first

  47. Section I.C.7.a.7. Hypertension, Secondary • Hypertension caused by an underlying condition • Code: • Underlying condition first • Type of hypertension (405) second

  48. Section I.C.7.a.8. Hypertension, Transient • Transient hypertension: Temporary elevation of BP • DO NOT assign 401-405 Hypertensive Disease • Hypertension diagnosis NOT established • Instead use: • 796.2, Elevated blood pressure • 642.3X, Transient hypertension of pregnancy

  49. Section I.C.7.a.9. Hypertension, Controlled • Hypertension controlled by therapy • Assign code from 401-405

  50. Section I.C.7.a.10. Hypertension, Uncontrolled • Untreated hypertension • Uncontrolled hypertension • Assign code from 401-405

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