1 / 54

Medical Insurance

Medical Insurance. Introduction to ICD-9-CM Chapter 4. ICD-9-CM. WHAT? International Classification of Diseases, 9th Revision, Clinical Modification WHY? HIPAA – mandated codes to report patients’ conditions on insurance forms HOW? With a 3, 4, or 5 digit code. ICD-9-CM.

nichole-osborn
Download Presentation

Medical Insurance

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Medical Insurance Introduction to ICD-9-CM Chapter 4

  2. ICD-9-CM WHAT? • International Classification of Diseases, 9th Revision, Clinical Modification WHY? • HIPAA – mandated codes to report patients’ conditions on insurance forms HOW? • With a 3, 4, or 5 digit code

  3. ICD-9-CM Addenda for the ICD-9-CM are released twice a year. Why is it important for a medical practice to receive the addendums? What steps should be taken by an insurance specialist as addendums are received?

  4. ICD-9-CM Expertise in diagnostic coding requires knowledge of • Medical terminology • Anatomy and physiology • Pathophysiology • Diagnostic coding also requires keeping abreast of current guidelines and experience applying correct coding rules.

  5. ICD-9-CM The complete ICD-9-CM consists of threevolumes • The Alphabetic Index, Diseases and injuries • The Tabular List, Diseases and injuries • Procedures

  6. ICD-9-CM • Two of the three volumes are used in medical offices • Volume 1 • Volume 2 Diseases and Injuries • One volume is used by facilities • Volume 3 Procedures

  7. Alphabetic Index CONVENTION Conventions are the standards and techniques used to give visual guidance, making the printed word more understandable. Many coding conventions will be discussed and exercises provided throughout this presentation

  8. Alphabetic Index The index is organized by condition, not by body part. The alphabetic index is used first in the process of coding.

  9. Alphabetic Index What are some other words for diagnostic statement? The reason for a patient’s encounter is found in the physician’s diagnostic statement

  10. Alphabetic Index Practice Which terms would you select to locate the code in the Alpha Index? • Fracture , right radius • Macular rash • Myocardial infarction • Foreign body in eye • Chronic otitis media • Paroxysmal tachycardia

  11. Alphabetic Index Answers • Fracture, right radius • Macular rash • Myocardial infarction • Foreign body in eye • Chronic otitis media • Paroxysmal tachycardia

  12. Alphabetic Index • Main terms • Are printed in boldface type and followed by its code number • Subterms • Appear below the main term and may show the etiology of the disease. • Supplementary terms • Appear in parenthesis to help clarify the term. They are not essential for coding.

  13. Alphabetic Index • Turnover lines • If the main term or subterm is too long to fit on one line, turnover (carryover) lines are used. • These lines are always indented farther to the right than subterms.

  14. Alphabetic Index • Cross-References • Always look up the cross referenced term as indicated by the wordsseeorsee also. • See • See also The main term was incorrect. The coder must refer to the referenced term. Other codes may be more appropriate. The coder may verify by checking the referenced terms.

  15. Examples Alphabetic Index Mainterm Cross reference Lump - see also Mass abdominal 789.3 breast 611.72 chest 786.6 Sub- terms

  16. Alphabetic Index Notes Notes are boxed, italicized instructions shown below a main term. The notes are important because they give specific instructions on selecting the correct code.

  17. Notes Alphabetic Index Epilepsy, epileptic (idiopathic) 345.9 Note - use the following fifth digit subclassification with categories 345.0, 345.1, 345.4 - 345.9 0 - without mention of intractable epilepsy 1 - with intractable epilepsy

  18. Alphabetic Index • The abbreviation NEC • Means not elsewhere classified • Use of the abbreviation means • There is no documentation to support a better-defined code or • No other code better matches the specific situation.

  19. Alphabetic Index • Multiple codes • Some conditions require two codes to accurately describe • Common Terms • Many terms appear more than once in the alphabetic index and are cross-referenced

  20. Alphabetic Index Multiple codes Episcleritis 379.00 gouty 274.89 [379.09] Hematuria ( benign) (Essential)(idiopathic) 599.7 due to S. haematobium 120.0

  21. Alphabetic Index • Eponyms • Eponyms are conditions or procedures named for a person • Eponyms are usually listed under that name and under the main term disease or syndrome.

  22. Alphabetic Index Examples Eponym • Hench - Rosenberg Syndrome (palindromic arthritis) (see also Rheumatism, palindromic) 719.3 Supplementary Terms Cross reference

  23. Tabular List The tabular list is organized in numerical order • The codes are arranged in chapters according to etiology or body system. • Codes may range from 3 to 5 digits, depending on specificity.

  24. Tabular List • Category • A three-digit code that covers a single disease or related condition • Subcategory • A four-digit subdivision of a category that indicates the etiology, site or manifestation • Subclassification • A five-digit subdivision of a subcategory

  25. Tabular List Examples Category 380 Disorder of external ear 380.0 perichondritis of pinna Subcategory

  26. Tabular List If the ICD-9-CM indicates a fifth digit is required, it must be included. Do not use zeroes as fillers if a fourth or fifth digit is not required. The following symbols may indicate the need to use a fifth digit §n P

  27. Tabular List • Includes and Excludes Notes • Notes headed by the word includes refine the content of the category or section • Notes headed by the word excludes indicate the conditions are NOT classifiable to the code above. • A colon : used in the includes and excludes notes indicates an incomplete term.

  28. Includes Tabular List 401 Essential hypertension • Includes:high blood pressure • hyperpiesia • hyperpiesis • hypertension(arterial)(essential)(primary) • (systemic) • hypertensive vascular: • degeneration • disease

  29. Elevated blood pressure • without diagnosis of hypertension (796.2) • pulmonary hypertension (416.0 - 416.9) • that involves vessels of : • brain (430 - 438) • eye (362.11) Excludes: Excludes Tabular List 401 Essential hypertension

  30. Tabular List • Parentheses ( )used around descriptors do NOT affect the code. • Brackets [ ]are used around synonyms, alternative wordings, or explanations. • Braces { } enclose a series of terms attached to a statement, similar to a colon, and indicates incomplete terms.

  31. Tabular List • A lozenge shows that a code is not part of the World Health Organization’s ICD. These codes only appear in the ICD-9-CM. • This symbol  ( a lozenge) may be ignored when coding diagnostic statements.

  32. Tabular List • The abbreviation NOS • Means not otherwise specified • Use of the abbreviation means • The condition is not adequately documented in the medical record. When possible more specific documentation should be requested from the provider.

  33. Tabular List Examples • NEC - not elsewhere classified 518.82 adult respiratory distress syndrome NEC • NOS- not otherwise specified 368.8 Blurred vision NOS

  34. Tabular List • You may need to use multiple codes when you see • “due to” or “associated with” in the diagnostic statement • “use additional code” or “code also” in the ICD-9-CM

  35. Tabular List Examples Episcleritis 379.00 gouty 274.89 [379.09] Hematuria ( benign) (Essential)(idiopathic) 599.7 due to S. haematobium 120.0

  36. V Codes V Codes can be used to describe encounters • with healthy patients using routine services • therapeutic encounters • as follow-up because of a history of a certain disease • preoperative evaluations

  37. V Codes V Codes can be used as a primary code or as an additional code

  38. V Codes Code It • Prophylactic vaccination against tetanus • Supervision of high risk pregnancy with history of abortion • Screening mammogram V03.7 V23.2 V76.12

  39. E Codes E codes are used to classify injuries and poisonings E Codes are never used as a primary code and cannot stand alone.

  40. E Codes Code It • Poisoning by eating mushrooms • Fall from scaffolding • Injury to hand with power saw E865.5 E881.1 E920.1

  41. Poisoning & Adverse Effects of Drugs960-979 Uses additional code to indicate the effect of the poisoning • 780.09 Unconsciousness • 986 Toxic effect of carbon monoxide • E982.0 Motor vehicle exhaust

  42. The Coding Process Step 1 • Determine the reason for the encounter Step 2 • Locate the term in the Alphabetic Index Step 3 • Verify the code in the Tabular List

  43. Coding Guidelines 1 Code the primary diagnosis first. Follow with any current co-existing conditions. 2Code to the highest degree of certainty. Never code inconclusive, rule-out diagnoses. 3Code to the highest level of specificity. Use fourth and fifth digits when available.

  44. Late Effects905 - 909 Require Two Codes 1. The residual effect 2. The cause of the late effect

  45. Late Effects905 - 909 Code It Arthritis right hand, due to fracture 5 years ago • 716.94 arthropathy, unspecified • 905.2 late effect of fracture of upper extremity

  46. Circulatory Disease Conditions caused by reduced blood flow to the heart • Ischemic heart disease • Coded under categories 410 to 414 What other conditions are classified here? • Myocardial infarctions • Coronary atherosclerosis • Arteriosclerotic heart disease (ASHD) • Angina Pectoris

  47. Neoplasms New growth, malignant or benign tumor

  48. Neoplasms • Neoplasm Table is in Alphabetic Index • Column headings include • Anatomical location • Malignant classifications • Primary, secondary and carcinoma in situ • Benign • Uncertain Behavior • Unspecified

  49. Neoplasms Code It 238.2 • neoplasm of skin of leg uncertain behavior • malignant neoplasm of upper outer quadrant of female breast 174.4

  50. Burns • Classified in categories 940 to 949. • Listed by • cause • severity • body surface

More Related