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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

ICD-9-CM Coding Guidelines

Presented by Cheryl Crosswhite, CPC

icd 9 cm official guidelines for coding and reporting
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

hipaa alert
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.
official guidelines for coding reporting
Official Guidelines for Coding & Reporting
  • Four Sections:

- Section I

- Section II

- Section III

- Section IV

general guidelines
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.
guidelines
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.
guidelines1
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
late effect
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)
chapter specific guidelines
Chapter-Specific Guidelines
  • Principal diagnosis
  • Principal procedure
  • Secondary diagnoses
  • Secondary procedures
  • First-listed diagnosis
chapter 1 infectious and parasitic diseases
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)
hiv positive status
HIV Positive Status
  • Key terms:

- HIV disease

- HIV infection

- HIV infected

- HIV positive

- Acquired immune deficiency syndrome (AIDS)

chapter 2 neoplasms
Chapter 2: Neoplasms
  • 140-239
  • Neoplasm

- “New growths or tumors in which cell

reproduction is out of control”

    • Benign
    • Malignant
chapter 2 neoplasms1
Chapter 2: Neoplasms
  • Six classifications:

- Primary malignancy

- Secondary malignancy

- Carcinoma (CA) in situ

- Benign

- Uncertain behavior

- Unspecified nature

chapter 2 neoplasms2
Chapter 2: Neoplasms
  • Contiguous sites (overlapping sites)
  • Re-excision of tumors
chapter 3 endocrine nutritional and metabolic diseases and immunity disorders
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

chapter 4 diseases of the blood and blood forming organs
Chapter 4: Diseases of the Blood and Blood-Forming Organs
  • 280-289
  • Hematopoiesis
  • Anemia
  • Red cell volume
  • Hemoglobin content
  • Shape (morphology)
  • Purpura
chapter 5 mental disorders
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.

chapter 5 mental disorders1
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.

chapter 6 nervous system and sense organs
Chapter 6: Nervous System and Sense Organs
  • 320-389
  • Nervous system, including meninges
  • Central nervous system

- Brain

- Spinal cord

  • Peripheral nervous system
chapter 7 circulatory system
Chapter 7: Circulatory System
  • 390-459
  • Hypertension, hypertensive table

- Malignant (accelerated)

- Benign

- Unspecified

  • Cerebral infarction, stroke, CVA
  • Late effects of cerebrovascular disease
  • Myocardial infarction
chapter 8 respiratory system
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
chapter 9 digestive system
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
chapter 10 genitourinary system
Chapter 10: Genitourinary System
  • 580-629
  • Chronic kidney disease (CKD)
  • Kidney transplant status (V42.0)
  • CKD with other conditions
chapter 11 pregnancy childbirth and puerperium
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
chapter 11 pregnancy childbirth and puerperium1
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)

chapter 11 pregnancy childbirth and puerperium2
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

chapter 11 pregnancy childbirth and puerperium3
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)

chapter 12 skin and subcutaneous tissue
Chapter 12: Skin and Subcutaneous Tissue
  • 680-709
  • Epidermis, dermis, subcutaneous tissue, nails, sebaceous glands, sweat glands, hair, and hair follicles
chapter 13 musculoskeletal system and connective tissue
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

chapter 14 congenital anomalies
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
chapter 15 conditions originating in perinatal period
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
chapter 16 symptoms signs ill defined conditions
Chapter 16: Symptoms, Signs, Ill-Defined Conditions
  • 780-799
  • Includes symptoms, signs and abnormal results of laboratory or other investigative procedures
chapter 16 symptoms signs ill defined conditions1
Chapter 16: Symptoms, Signs, Ill-Defined Conditions
  • Key terms:

- Abnormal, abnormality

- Decrease, decreased

- Elevation

- Findings, abnormal, without diagnosis

chapter 17 injury and poisoning
Chapter 17: Injury and Poisoning
  • 800-999
  • Injuries
  • Fractures
  • Burns
  • Adverse effects, poisonings, and toxic effects
fractures
Fractures
  • Open/Compound fracture
  • Closed/Simple fracture

- Comminuted

- Depressed

- Fissured

- Greenstick

- Impacted

fractures1
Fractures
  • Closed/Simple fracture

- Linear

- Slipped epiphysis

- Spiral fracture

  • Complicated
  • Malunion (late effect)
burns
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
adverse effects poisonings and toxic effects
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

poisoning
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
poisoning1
Poisoning
  • 960-979
  • Manifestation of poisoning
  • Accidental (E850-E869)
  • Suicide attempt (E950-E952)
  • Assault (E961-E962)
  • Undetermined (E980-E982)
toxic effects
Toxic Effects
  • When someone ingests or comes into contact with a harmful substance
v codes
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
v codes1
V Codes
  • Categories:

- Contact/Exposure

- Inoculations and vaccinations

- Status

- History (of)

- Screening

- Observation

- Aftercare

v codes2
V Codes
  • Categories, cont.

- Follow-up

- Donor

- Counseling

- Obstetrics and related conditions

- Newborn, infant, and child

- Routine and administrative examinations

- Miscellaneous

e codes
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
e codes1
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)
e codes2
E Codes
  • Place of occurrence (E849)

- Describes place where event occurred, NOT patient’s activity at

the time