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ICD-9-CM Coding Guidelines

ICD-9-CM Coding Guidelines . Presented by Cheryl Crosswhite, CPC. ICD-9-CM Official Guidelines for Coding and Reporting. Partial Freeze of Revisions: October 1, 2011 – last major update of ICD-9-CM Annual update to ICD-9 is provided online on the CDC website:

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ICD-9-CM Coding Guidelines

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  1. ICD-9-CM Coding Guidelines Presented by Cheryl Crosswhite, CPC

  2. ICD-9-CM Official Guidelines for Coding and Reporting • Partial Freeze of Revisions: October 1, 2011 – last major update of ICD-9-CM • Annual update to ICD-9 is provided online on the CDC website: http://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm

  3. HIPAA Alert! • HIPAA regulations require providers and third party payers to adhere to ICD-9-CM Official Guidelines for Coding and Reporting. • A violation of coding guidelines is a violation of HIPAA.

  4. Official Guidelines for Coding & Reporting • Four Sections: - Section I - Section II - Section III - Section IV

  5. General Guidelines • Use both the ICD-9-CM Index to Diseases and the Tabular List of Diseases. • Locate term in the Index to Diseases first, and verify the code in the Tabular List of Diseases. • Assign the highest level of digits available.

  6. Guidelines • Signs and symptoms that are integral to the disease should not be assigned as additional codes. • The etiology and manifestation convention requires two codes to be reported to completely describe a single condition.

  7. Guidelines • Multiple coding - Use additional code - Code first - If applicable, code any causal condition first • Acute (or subacute) and chronic conditions • Combination code versus multiple code

  8. Late Effect • Residual condition that develops after acute phase of illness or injury has ended - No time limit on reporting • For example, traumatic arthritis (residual) following fracture of the left ankle three years ago (cause) (716.17, 905.4) • Combination code assigned, for example aphasia due to cerebrovascular accident 6 months ago (438.11)

  9. Chapter-Specific Guidelines • Principal diagnosis • Principal procedure • Secondary diagnoses • Secondary procedures • First-listed diagnosis

  10. Chapter 1: Infectious and Parasitic Diseases • 001-139 • Organisms • Infections • “Supplemental Classification of Factors Influencing Health Status and Contact with Health Services” • Human immunodeficiency virus (HIV)

  11. HIV Positive Status • Key terms: - HIV disease - HIV infection - HIV infected - HIV positive - Acquired immune deficiency syndrome (AIDS)

  12. Chapter 2: Neoplasms • 140-239 • Neoplasm - “New growths or tumors in which cell reproduction is out of control” • Benign • Malignant

  13. Chapter 2: Neoplasms • Six classifications: - Primary malignancy - Secondary malignancy - Carcinoma (CA) in situ - Benign - Uncertain behavior - Unspecified nature

  14. Chapter 2: Neoplasms • Contiguous sites (overlapping sites) • Re-excision of tumors

  15. Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders • 240-279 • Diabetes mellitus - Type I: Patient’s body unable to produce insulin - Type II: Patient’s body unable to properly use insulin produced

  16. Chapter 4: Diseases of the Blood and Blood-Forming Organs • 280-289 • Hematopoiesis • Anemia • Red cell volume • Hemoglobin content • Shape (morphology) • Purpura

  17. Chapter 5: Mental Disorders • 290-319 • WHO guidelines: - When classifying behavioral disorders, organically based illnesses are reported before functional illnesses. - Within a functional group, classify disorders as psychoses, neuroses, personality disorders, and others.

  18. Chapter 5: Mental Disorders • WHO Guidelines: - When coding mental illnesses associated with physical conditions, assign as many codes as necessary to fully describe the clinical picture.

  19. Chapter 6: Nervous System and Sense Organs • 320-389 • Nervous system, including meninges • Central nervous system - Brain - Spinal cord • Peripheral nervous system

  20. Chapter 7: Circulatory System • 390-459 • Hypertension, hypertensive table - Malignant (accelerated) - Benign - Unspecified • Cerebral infarction, stroke, CVA • Late effects of cerebrovascular disease • Myocardial infarction

  21. Chapter 8: Respiratory System • 460-519 • Nose, sinuses, pharynx, larynx, trachea, bronchi, and lungs • Chronic obstructive pulmonary disease - Refer to main term “obstruction” • Pneumonia • Asthma (status asthmaticus) • Acute exacerbation

  22. Chapter 9: Digestive System • 520-579 • Major digestive organs include pharynx, esophagus, stomach, and intestines • Accessory (secondary) organs include salivary and parotid glands, jaw, and teeth • Structures that support the digestive process are gallbladder, pancreas, and liver

  23. Chapter 10: Genitourinary System • 580-629 • Chronic kidney disease (CKD) • Kidney transplant status (V42.0) • CKD with other conditions

  24. Chapter 11: Pregnancy, Childbirth, and Puerperium • 630-677 • Conditions occurring during pregnancy, childbirth, and six weeks immediately following childbirth • Never report these codes on baby’s record • Outcome of delivery (V27.0-V27.9

  25. Chapter 11: Pregnancy, Childbirth, and Puerperium • 630-633 (ectopic or molar pregnancy) • 639 (complications following abortion and ectopic or molar pregnancy) • Fifth digits to identify abortive stage - Unspecified (0) - Incomplete (1) - Complete (2)

  26. Chapter 11: Pregnancy, Childbirth, and Puerperium • 640-648 (complications related to pregnancy) • 650 (normal delivery) - Minimal or no assistance - Episiotomy permitted - Fetal manipulation (e.g., use of forceps) not permitted

  27. Chapter 11: Pregnancy, Childbirth, and Puerperium • Fifth digit required for current episode of care - Unspecified as to episode of care (0) - Delivered with or without mention of antepartum condition (1) - Delivered with mention of postpartum complication (2) - Antepartum condition or complication (3) - Postpartum condition or complication (4)

  28. Chapter 12: Skin and Subcutaneous Tissue • 680-709 • Epidermis, dermis, subcutaneous tissue, nails, sebaceous glands, sweat glands, hair, and hair follicles

  29. Chapter 13: Musculoskeletal System and Connective Tissue • 710-739 • Bones, muscles, cartilage, fascia, ligaments, synovia, tendons, and bursa • Localized osteoarthrosis - Primary, unknown etiology - Secondary, caused by external or internal injury

  30. Chapter 14: Congenital Anomalies • 740-759 • Classifies all conditions according to a principal or defining defect rather than cause - Except for chromosome abnormalities • May be apparent at birth or hidden and identified sometime after birth • Codes may be used throughout patient’s life

  31. Chapter 15: Conditions Originating in Perinatal Period • 760-779 • Perinatal period - Interval of time before, during, and up to 28 days following birth • NEVER report these codes for the mother’s episode of care

  32. Chapter 16: Symptoms, Signs, Ill-Defined Conditions • 780-799 • Includes symptoms, signs and abnormal results of laboratory or other investigative procedures

  33. Chapter 16: Symptoms, Signs, Ill-Defined Conditions • Key terms: - Abnormal, abnormality - Decrease, decreased - Elevation - Findings, abnormal, without diagnosis

  34. Chapter 17: Injury and Poisoning • 800-999 • Injuries • Fractures • Burns • Adverse effects, poisonings, and toxic effects

  35. Fractures • Open/Compound fracture • Closed/Simple fracture - Comminuted - Depressed - Fissured - Greenstick - Impacted

  36. Fractures • Closed/Simple fracture - Linear - Slipped epiphysis - Spiral fracture • Complicated • Malunion (late effect)

  37. Burns • 940-949 • Classified according to: - Depth • First degree (erythema) • Second degree (blistering) • Third degree (full thickness) - Extent • Percentage of body surface - Agent (e.g., chemicals, fire, sun) • E Codes assigned

  38. Adverse Effects, Poisonings, and Toxic Effects • Adverse effect (adverse reaction) - Appearance of pathologic condition caused by ingestion or exposure to chemical substance properly administered or taken - For example, allergic rash due to penicillin - Table of Drugs and Chemicals

  39. Poisoning • Occurs as result of overdose • Wrong substance administered or taken or intoxication that involves combining prescribed drugs with non-prescribed drugs or alcohol • For example, coma due to overdose of codeine

  40. Poisoning • 960-979 • Manifestation of poisoning • Accidental (E850-E869) • Suicide attempt (E950-E952) • Assault (E961-E962) • Undetermined (E980-E982)

  41. Toxic Effects • When someone ingests or comes into contact with a harmful substance

  42. V Codes • V01-V85 • Supplementary Classification of Factors Influencing Health Status and contact with Health Services • Classifies occasions when circumstances other than disease or injury are recorded as diagnoses or problems

  43. V Codes • Categories: - Contact/Exposure - Inoculations and vaccinations - Status - History (of) - Screening - Observation - Aftercare

  44. V Codes • Categories, cont. - Follow-up - Donor - Counseling - Obstetrics and related conditions - Newborn, infant, and child - Routine and administrative examinations - Miscellaneous

  45. E Codes • E800-E999 • Supplemental Classification of External Causes of Injury and Poisoning • Classifies environmental events, circumstances, and conditions as cause of injury, poisoning, or other adverse effect

  46. E Codes • Reported in addition to a code from Chapters 1-17 to indicate nature of condition • Machinery accidents (E919) • Late effects of accidents (E929, E959, E969, E977, E989, E999) • Transport accidents (E800-E848)

  47. E Codes • Place of occurrence (E849) - Describes place where event occurred, NOT patient’s activity at the time

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