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CHAPTER 14

CHAPTER 14. AN OVERVIEW OF THE ICD-9-CM. An Overview of the ICD-9-CM. Classification System Morbidity (illness) Mortality (death) ICD = International Classification of Diseases WHO’s ICD-9 used globally World Health Organization ICD-9-CM = 9th edition; CM, Clinical Modification

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CHAPTER 14

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  1. CHAPTER 14 AN OVERVIEW OF THE ICD-9-CM

  2. An Overview of the ICD-9-CM • Classification System • Morbidity (illness) • Mortality (death) • ICD = International Classification of Diseases • WHO’s ICD-9 used globally • World Health Organization • ICD-9-CM = 9th edition; CM, Clinical Modification • Continuity of data (Cont’d…)

  3. Overview (…Cont’d) • 1977: US develops ICD-9-CM version • More code subsets define medical care • ICD-9-CM data comparable to global data (ICD-9) • Updated October 1 of each year • Must use new codes as of October 1 • Also updates April 1 with no grace period

  4. Medicare • Medicare Catastrophic Act of 1988 • Required use of ICD-9-CM codes for diagnosis • Act repealed 1989, but codes still used • Effective 2003, all claims must have valid diagnosis • Excludes ambulance suppliers

  5. Uses of ICD-9-CM • Facilities track patientuse through codes • Fiscal entities track health care costs (Cont’d…)

  6. Uses of ICD-9-CM (…Cont’d) • Research • Health care quality • Future needs • Newer cancer center built if patient use warrants

  7. ICD-9-CM Documents Medical Necessity • Diagnoses establish medical necessity • Services and diagnoses must correlate • Correct diagnosis codes allow: • Accurate reimbursement • Fewer rejected claims • Reduced risk of sanctions/fines from audit

  8. CMS-1500 (08/05) in Blocks 21 and 24E (Outpatient) Courtesy U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

  9. UB04 in Blocks 66-74 (Inpatient) • Replaced UB-92, 02/07 Courtesy U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

  10. Ethics • Documentation must support diagnosis • Example: • Services provided • Diagnosis justifies services • If in doubt, check it out; don’t make assumptions

  11. Your Job • Translate documentation into ICD-9-CM codes • Legionnaires’ disease = 482.84 • Assign code to highest level specificity • Medical record must substantiate diagnosis code assignment

  12. Format of the ICD-9-CM • Volume 1, Diseases, Tabular List (diagnosis) (17 chapters) • Volume 2, Diseases, Alphabetic Index (diagnosis) (3 sections) • Volume 3, Procedures, Tabular List and Alphabetic Index (inpatient)

  13. Volume 1, Diseases, Tabular List • Contains code numbers • 001.0-999.9 Diagnosis codes describe condition • V and E codes = supplemental information

  14. Volume 2, Diseases, Alphabetic Index • Appears first in book • Terms and code numbers verified inVolume 1 • Never code directly from Index! • Read all notes and follow instructions (ex., see also) • Tables (ex., Drugs/Chemicals, Hypertension)

  15. Volume 3, Procedures, Tabular List and Alphabetic Index • Not used for physician services • Index and Tabular List used for procedures and therapies • Inpatient settings only • Procedures and therapies • Maximum 4 digits • 20.41 Simple mastoidectomy

  16. ICD-9-CM Conventions • Punctuation: [ ], ( ), :, }, italicized and bold type, [ ] • Symbols: §  • Abbreviation: NEC, NOS • Notations: Includes, Excludes, Use Additional Code, And/With, Code if Applicable

  17. [ ] Brackets • Enclose synonyms, alternative wording, or explanatory phrases • Helpful, additional information • Can affect code • Found only in Tabular List (001.0-999.9)

  18. ( ) Parentheses • Contain non-essential modifiers • Take them or leave them • Do not affect code • Found in Tabular List and Index • Do not affect code

  19. Colon and Brace • : Colon: In Tabular List,completesa statement with one or more modifiers • } Brace: In Tabular List,modifiesstatements to the right of the brace

  20. Italicized andBoldType • Italicized • All Excludes notes • Codes not used as principal diagnosis • Bold • Codes and code titles in Tabular List, Volume 1

  21. Slanted Brackets [ ] • Enclose manifestationsof underlying condition • “Code first underlying disease”

  22. Lozenge and Section Mark •  Lozenge: Indicates codesunique to ICD-9-CM • § Section: Can befootnoteindicator

  23. Abbreviations • NEC: Not elsewhere classifiable • No more specific code exists • NOS: Not otherwise specified • Unspecified in documentation

  24. Includes, Excludes, and Use Additional Code • Includes notes: In chapter, section, or category • Excludes notes: Conditions are coded elsewhere • Use Additional Code: Assignment of other code(s) is necessary

  25. And/With • And: Means and/or • Example: 237.0, Neoplasm of uncertain behavior of pituitary gland and craniopharyngeal duct • With: Means one condition with (in addition to) another condition • Example: 070.41, acute hepatitis C with hepatic coma

  26. Code, If Applicable, Any Causal Condition First • May be primary diagnosis if no causal condition applicable or known or documented (Cont’d…)

  27. Code, If Applicable, Any Causal Condition First (…Cont’d) • Example: 707.10, Ulcer of lower limb, except decubitus; states: • Chronic venous hypertension with ulcer (459.31) • If ulcer caused by chronic venous hypertension: • First: 459.31 chronic venous hypertension • Second: 707.10 ulcer of lower limb

  28. Volume 2, Alphabetic Index • Nonessential modifiers enclosed in parentheses(does not have to be in diagnostic statement) • Have noeffect on code selection • Clarify diagnosis • Example: Ileus (adynamic) (bowel)….

  29. Volume 2, Terms • Main terms(bold typeface) • Subterms • Indented two spaces to right • Not bold • Example Pain (Main term in bold) orbital region 379.91 (subterm indented)

  30. Volume 2, Cross References • Directs you: see, see also, see categories • “see” directs you to specific term • Example: Panotitis—“see” Otitis media • “see also” directs you to another term for more information • Example: Perivaginitis (see also Vaginitis) (Cont’d…)

  31. Volume 2, Cross References (…Cont’d) • “see category” Volume 1, Tabular List, specific information about use of code • Example: Mesencephalitis (see also Encephalitis) 323.9; late effect—see category 326

  32. Volume 2, Notes • Define terms • Give further coding instructions • Example: Index: “Melanoma,” • Note: “Except where otherwise indicated….” (Cont’d…)

  33. Volume 2, Notes (…Cont’d) • Mandatory fifth digits also appear as notes (one reason to never code from Index) Figure: 14.4 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

  34. Volume 2, Eponyms • Disease or syndrome named for person • Example: • Arnold-Chiari (see also Spina bifida) • Sturge-Weber • Prader-Willi

  35. Volume 2, Etiology and Manifestation of Disease • Etiology = cause of disease • Manifestation = symptom • Etiology + Manifestation = Combination codes

  36. Combination Code Figure: 14.5 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

  37. Multiple Coding Figure: 14.6 • No combination code, useindividualcode(s) in this order • 250.4x • 581.81 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

  38. Volume 2, Neoplasm • In Volume 2, Index, locate Neoplasm Table under the alphabetic entry “N” • Do not reference Neoplasm table when diagnostic statement states “mass” Figure: 14.7 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

  39. Volume 2, Sections • Section 1, Index to Diseases • Section 2, Table of Drugs and Chemicals • Section3, Index to External Causes of Injuries and Poisonings (E Codes) • Never primary diagnosis • Medicare does not accept for professional billing

  40. Section 1, Index to Diseases • Largest part of Volume 2—Index • First step in coding, locate main bold term in the Index • Subterms indented 2 spaces to the right • May have more than one subterm • 3 digits = category codes • 4 digits = subcategory • 5 digits = subclassification codes

  41. Section 2, Table of Drugs and Chemicals • Drug name placedalphabetically on left under heading “Substance” (Cont’d…) From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

  42. Table of Drugs and Chemicals (…Cont’d) • First column: “Poisoning” code for substance involved, wrong substance given or taken • First-listed before manifestation condition (Cont’d…) From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

  43. Table of Drugs and Chemicals (…Cont’d) • E codes identify how poisoning occurred • Example: If analgesics poisoning occurred by accident, E850.9 • Correct order poisoning • 3 codes required: • Identify agent analgesic 965.9 • Condition—coma 780.01 • Accidental poison E850.9 • Adverse effect • 2 codes required • Condition—coma 780.01 • Therapeutic E935.9

  44. Table of Drugs and Chemicals: Headings • Accident: Unintentional • Therapeutic: Correct dosage, correctly administered, with adverse effects (example, allergic reaction) • Suicide attempt (must be documented) • Assault: Intentionally inflicted by another person • Undetermined: Unknown intent

  45. Section 3, E Codes • Alphabetic Index to External Causes of Injuries and Poisonings • Provide additional information about the nature of injury/poisoning and locality • Never aprincipal (inpatient) or first-listed(outpatient) diagnosis (Cont’d…)

  46. Section 3, E Codes (…Cont’d) • Separate Index to External Causes • Alphabetical, main terms in bold • Subterms are indented 2 to right under main term • Some words in Index not in Tabular—saves space • That is why you must locate the term in the Index, then locate in Tabular

  47. Index to External Causes: Example • Main terms are type of accident (Collision) • Subterms are circumstancesof the accident (motor vehicle) From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

  48. A Word of Caution About the Alphabetic Index (Section I, Vol. 2) • Some words in Index do not appear in Tabular—saves space • Exact word may not be in code Tabular description • But found in Alphabetic Index • That is why you must locate term in Index and then locate Tabular (follow where Index directs)

  49. Volume 1, Tabular List • Two major divisions • Classification of Diseases and Injuries (codes 001.0-999.9) • Supplementary Classification (V codes and E codes)

  50. Classification of Diseases and Injuries • Main portion of ICD-9-CM • Codes from 001.0-999.9 • Most chapters are body systems • Digestive System • Respiratory System

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