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Intro to ICD-9 Coding. Nancy Clark, M.Ed. Director of Medical Informatics Education FSU College of Medicine. ICD-9 Coding book Pages refer to Medicode book. Page numbers may not match other books. A medical reference with ICD-9 codes Online ICD-9 coder at CDC Wonder. PDA Coding Programs

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intro to icd 9 coding

Intro to ICD-9 Coding

Nancy Clark, M.Ed.

Director of Medical Informatics Education

FSU College of Medicine

class resources needed
ICD-9 Coding book

Pages refer to Medicode book. Page numbers may not match other books.

A medical reference with ICD-9 codes

Online ICD-9 coder at CDC Wonder

PDA Coding Programs


Epocrates ICD

Bluefish RX ICD and CPT


ICD Notes

Pocket ICD/CPT

StatICD, StatE&M, others

ICD-9-CM pocket

Class Resources Needed
  • Learner will correctly describe a diagnosis so that a billing clerk can assign an ICD-9 code(s) to the encounter
  • Learner will correctly assign an ICD-9 code(s) to an encounter using the ICD-9 book
  • Learner will correctly assign an ICD-9 code(s) to an encounter using a computer program, PDA program or web site.
international classification of disease 9th revision
International Classification of Disease, 9th Revision
  • 1948 - WHO developed to track diseases
  • 1977 - 9th revision published
  • 1988 - Congress passed Medicare Catastrophic Coverage Act requiring use of ICD-9 on all claims.
  • 1996 - mandated codes be of highest possible specificity.
hcfa guidelines
HCFA Guidelines
  • Identify each service, procedure, or supply with an ICD-9 code from 001.0 through V82.9 to describe the diagnosis, symptom, complaint, condition, or problem
  • Identify services or visits for circumstances other than disease or injury, such as follow-up care after chemotherapy, with V codes provided for this purpose.
hcfa guidelines1
HCFA Guidelines
  • Code the primary diagnosis first, followed by the secondary, tertiary and so on. Code any coexisting conditions that affect the treatment of the patient for that visit or procedure as supplementary information. Do not code a diagnosis that is no longer applicable.
hcfa guidelines2
HCFA Guidelines
  • Code to the highest degree of specificity. Carry the numerical code to the 4th or 5th digit when necessary. Remember, there are only approximately 100 valid three digit codes; all other ICD-9 codes require additional digits
hcfa guidelines3
HCFA Guidelines
  • Code a chronic diagnosis as often as it is applicable to the patient’s treatment at this encounter.
  • When only ancillary services are provided, list the appropriate V code first and the problem second.
  • For surgical procedures, code the diagnosis applicable to the procedure.
organization of icd 9 volume 1
Organization of ICD-9 Volume 1

001-139 Infectious and Parasitic Diseases

140-239 Neoplasms

240-279 Endocrine, Nutritional and Metabolic Diseases

280-289 Diseases of the Blood and Blood-forming Organs

290-319 Mental Disorders

320-389 Diseases of the Nervous System and Sense Organs

390-459 Diseases of the Circulatory System

460-519 Diseases of the Respiratory System

520-579 Diseases of the Digestive System

580-589 Diseases of the Genitourinary System

630-676 Complications of Pregnancy, Childbirth, and the Puerperium

680-709 Diseases of the Skin and Subcutaneous Tissue

organization of icd 9 volume 11
Organization of ICD-9 Volume 1

710-739 Diseases of the Musculoskeletal System & Connective Tissue

740-759 Congenital Anomalies

760-779 Certain Conditions Originating in the Perinatal Period

780-799 Symptoms, Signs and Ill-defined Conditions

800-999 Injury and Poisoning

E800-E999 Supplementary Classification of the External Causes of Injury and Poisoning

V01-V82 Supplementary Classification of factors influencing Health Status and Contact with Health Services

key to symbols
Key to Symbols

Additional Digits Required

Nonspecific Code

Not a Primary Diagnosis

Not Elsewhere Classified

Not Otherwise Specified





Symbols may vary with different books.

Look for Key at beginning of Volume 1.

icd 9 volume 2
Section 1 - Alphabetic Index to Diseases

Section 2 - Table of Drugs and Chemicals

Section 3 - Index to External Causes

Handy Tables



ICD-9 Volume 2
using book
Using Book
  • Look up first 3 digits in Volume 2 Indices
    • Pain, Chest 786.5
using book1
Using Book
  • Turn to that ICD code in Volume 1

786.5 Chest pain

786.50 Chest pain, unspecified

786.51 Precordial pain

786.52 Painful respiration

Pain: Pleurodynia

anterior chest wall


epidemic pleurodynia (074.1)

786.59 Other


Pressure in chest



new acute problem diagnosable
New, Acute Problem, Diagnosable
  • Look up diagnosis in Volume 2
  • Go to Code # in Volume 1
  • Pick specific location, type, severity, complication, and/or manifestation
  • Find appropriate 4th and 5th digits

Bronchitis, acute, probably viral


new acute or chronic problem that you can t diagnose this visit
New Acute or Chronic Problem that you can’t diagnose this visit
  • Code the symptom

Abdominal swelling or mass in epigastric area


Elevated blood pressure


check up for chronic problem well child well adult with no complaints sequelae or complications
Check-up for Chronic Problem, Well Child, Well Adult with No Complaints, Sequelae, or Complications
  • Use a V Code and/or Code for Chronic Problem
  • Look up Examination in Volume 2

Well Child v20.2 (EPSDT different)

General Physical v70.0

Gynecological exam v72.3

more on annual physicals
More on Annual Physicals
  • Use Family History of … as second diagnosis when applicable to justify

Family History of colon cancer V16.0

follow up for previous acute condition with no problems
Follow-up for Previous Acute Condition, with no problems
  • Don’t Code for the acute condition which no longer exists
  • Use a V Code
  • Look up “History of” or “Aftercare” unless it was an accident

Follow-up for pneumonia(fully healed)


follow up to previous acute problem there are complications
Follow-up to Previous Acute Problem, there are complications
  • Look up “Late Effects” or the specific condition(s)
  • Patient develops infection in wound on hand you sutured three days ago


chronic problems with sequelae
Chronic Problems with Sequelae
  • Requires two codes:
  • Code the Chronic Problem first
  • Code the Complication second

Type 2 diabetic develops peripheral neuropathy

Type 2 DM with neurological manifestations 250.60

Peripheral neuropathy 337.1

accidents suicides poisonings external causes
Accidents, Suicides, Poisonings . . . External Causes
  • Use E codes and/or Injury and Poisoning
  • Look up injury in Index, circumstances in E-Codes

Elderly patient fell, sprained internal collateral ligament in ankle while stepping from curb:

Sprains and strains of ankle and foot 845.01

Fall on or from sidewalk curb E880.1

drug side effects
Drug Side-Effects
  • Use Section 2 of Volume 2, p353
  • Will require 3 codes: the side effect, the code for poisoning for the drug and the E-code for the therapeutic use of the drug.

Patient develops hives after taking penicillin

Allergic urticaria 708.0

Penicillin poisoning 960.0

Therapeutic penicillin E930.0

using it coding aids
Online ICD-9 Search at CDC Wonder

InfoRetriever on PDA, desktop or online

ICD-9 Coding module

5 Minute Clinical Consult

Encoder Pro and Code-it-Fast

First Consultonline

Other PDA coding software

Bluefish RX ICD and CPT


ICD Notes

Pocket ICD/CPT

StatICD, StatE&M, others

ICD-9-CM pocket

Using IT Coding Aids
references and resources
References and Resources
  • Sulkes, S. Coding and Documenting for Reimbursement. In: Coleman, W. (2001) Family Focused Behavioral Pediatrics. Lippincott Williams & Wilkins, Philadelphia, PA. Available at Books@OVID