ICD-9-CM General Guidelines - Coding for Diseases and Conditions

1. CHAPTER 4 USING ICD-9-CM

2. 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 Chapter 11, Complications of Pregnancy, Childbirth, and the 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 Poisoning and E Codes Basic Coding Guidelines ICD-10-CM Using ICD-9-CM

3. Using ICD-9-CM • Guidelines developed by cooperating parties • AHA (American Hospital Association) • AHIMA (American Health InformationManagement Association) • CMS (Centers for Medicare andMedicaid Services) • NCHS (National Center for Health Statistics)

4. General Guidelines • Appendix A of text contains official Guidelines • Inpatient coders use Sections I-III of Guidelines • Outpatient coders primarily use Sections I and IV, however… (Cont’d…)

5. General Guidelines (…Cont’d) • Basic coding guidelines do NOT cover all situations • Outpatient coders also use many inpatient guidelines

6. 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

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

8. Guideline Section I.B.3. Level of Detail in Coding • Assign diagnosis to highest level of specificity • Do NOT use three-digit code if there is fourth • Do NOT use four-digit code if there is fifth • If not specific, claims bounce!

9. 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

10. 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

11. 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…)

12. 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

13. 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…)

14. 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…)

15. Section I.B.10. Acute and Chronic Conditions (…Cont’d) • Combination code: Both acute and chronic condition • Diarrhea (acute) (chronic) 787.91 • Acute and subacute bacterial endocarditis 421.0 • Otitis acute and subacute 382.9

16. 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

17. 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…)

18. Late Effects (…Cont’d) • Late effect codes not in separate chapter • Rather throughout Tabular • Reference the term “Late” in the Index • There is no time limit on developing a residual • There may be more than one residual • Example: Patient had a stroke and has residual paralysis on dominant side (hemiparesis, 438.21) and aphasia,438.11 • Late effect means the original injury has healed and you are dealing with a “residual” condition

19. Section I.C.7.d. Late Effects of Cerebrovascular Disease • 438 indicates conditions classified to 430-437 as causes of Late Effects • Code V12.54 • Assigned for TIA and cerebral infarction without residual deficits • Do not report from category 438

20. ConclusionCHAPTER 4 USING ICD-9-CM