ICD-9-CM

1. ICD-9-CM General Guidelines

2. Diagnostic Coding Guideline A • Term first-listed diagnosis, rather than principal diagnosis • Outpatient Surgery: Reason for surgery • Even if surgery is cancelled due to contraindication

3. Diagnostic Coding Guideline A • Observation Stay: Medical condition that occasioned admission • Assign a code from medical condition • Observation Stay: Complications from outpatient surgery lead to observation report: • Reason for surgery as first reported diagnosis • Codes for complications necessitating observation

4. Selection of First-Listed Diagnosis • Condition for encounter • Why patient presented, not necessarily most serious condition noted • Documented • Chiefly responsible for services provided • Also listco-existingconditions

5. Diagnosis and Services • Diagnosis and procedure MUST correlate • Medical necessity must be established through documentation • No correlation = No reimbursement

6. Symptoms, Signs, and Ill-Defined Conditions • Can be the first-listed diagnosis if no more specific diagnosis available • Diagnoses often are not established at the time of the initial encounter/visit

7. Diagnostic Coding Guideline B • Use codes 001.0 through V89.09 to code: • Diagnosis • Symptoms • Conditions • Problems • Complaints • Or other reason(s) for visit

8. Diagnostic Guideline C • Documentation should describe patient's condition, using terminology that includes: • Specific diagnoses • Symptoms • Problems • Reasons for encounter

9. Diagnostic Guideline D • Selection of codes 001.0 through 999.9 (Chapters 1-17) frequently used to describe reason for encounter

10. Diagnostic Guideline E • Codes that describe symptoms and signs, as opposed to diagnoses, acceptable for reporting purposes when • An established diagnosis has NOT been determined by physician

11. Diagnostic Guideline F • V codes deal with encounters for circumstances other than disease or injury • Example: Well-baby checkup • See Section I.C.18 for information onV codes

12. V Codes • Located after 999.9 in Tabular • Two digits before decimal (e.g., V10.1X) • Index for V codes is Alphabetic Index to Diseases • Main terms: • Contraception • Counseling • Dialysis • Status • Examination

13. Uses of V Codes • Not sick BUT receives health care (e.g., vaccination) • Services for known/resolving disease/injury (e.g., chemotherapy) • Codes for “aftercare” (e.g., surgery or fracture) • Indicate birth status/outcome of delivery (Cont’d…)

14. Uses of V Codes (…Cont’d) • A circumstance/problem that influences patient’s health BUT NOTcurrent illness/injury • Example: Organ transplant status • Example: Birth status and outcome of delivery (newborn) • Section I.18.e. of Guidelines contains the V Code Table • Identifies if V code can be listed as first, first/additional, additional only

15. History V Code Categories in Tabular • V10 Personal history of malignant neoplasm • V12 Personal history of certain other diseases • V13 Personal history of other diseases • V14 Personal history of allergy to medicinal agents • V15 Other personal history presenting hazards to health • V16 Family history of malignant neoplasm • V17 Family history of certain chronic disabling diseases • V18 Family history of certain other specific diseases • V19 Family history of other conditions Condition no longer present or treated

16. Diagnostic Guideline G • Codes have either 3, 4, or 5 digits • 4 and/or 5 digit codes provide greater specificity (detail) (Cont’d…)

17. Diagnostic Guideline G (…Cont’d) • 3-digit code used ONLY if no 4 or 5 digit • Where 4 and/or 5 digits provided, must be assigned • Diagnoses NOT coded to full digits available invalid • Claims bounce!

18. Diagnostic Guideline H • List first code for diagnosis, condition, problem, or other reason for encounter/visit shown in medical record to be chiefly responsible for services provided • List additional codes that describe any coexisting conditions • Assign V72.5 and/or V72.6x for routine lab/radiology test ordered without signs, symptoms, or associated diagnosis

19. Diagnostic Guideline I • Do NOT code diagnoses documented as probable, suspected, questionable, rule out, or working diagnoses • Rather, code condition(s) to suspected highestdegree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for visit

20. Diagnostic Guideline J • Chronic diseases treated on an ongoing basis may be coded and reportedas many times as patient receives treatment and care for condition(s)

21. Diagnostic Guideline K • Code all documented conditions that coexist at time of visit, that require or affectpatient care, treatment, or management • Do NOT code conditions previously treated, no longer existing (Cont’d…)

22. Diagnostic Guideline K (…Cont’d) • “History of” codes (V10-V19) may be used as secondary codes if: • Impacts current care or treatment

23. Diagnostic Guidelines L and M • For patients receiving diagnostic services ONLY • Sequence first • Diagnosis • Condition • Problem OR • Other reason shown in medical record to be chiefly responsible for encounter (…Cont’d)

24. Diagnostic Guidelines L and M (…Cont’d) • Codes for other diagnoses (e.g., chronic conditions) • May be sequenced as secondary diagnoses • Exception: Therapeutic Services • Patients receivingchemotherapy (V58.11), radiation therapy(V58.0), or rehabilitation (V57.0-V57.9) • V code first diagnosis and problem for which service being performed second

25. Diagnostic Guideline N • For patients receiving preoperative evaluations ONLY • Code from category V72.8 (Other specified examinations) • Assign secondary code for reason for surgery • Code also any findings related to preoperative evaluation

26. Diagnostic Guideline O, Ambulatory Surgery • Code diagnosis which required ambulatory surgery • Pre- and post-op diagnosis different • Code the post-op diagnosis

27. Diagnostic Guideline P • Code routine prenatal visits with no complications: • V22.0 (Supervision of normal first pregnancy) • V22.1 (Supervision of other normal pregnancy) • DO NOT use these codes with pregnancy complication codes (Chapter 11, ICD-9-CM)

28. ICD-9-CM CODING Conclusion – General Guidelines