5 Introduction to ICD-10-CM
4 ICD-9-CM Chapter-Specific Guidelines, Part II: Chapters 1119
3 ICD9CM Chapter-SpecificGuidelines, Part I: Chapters 110
2 Introduction to ICD-9-CM
ICD9CM AND ICD10CM
P A R T
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Key Terms2.1 Explain the structure of the ICD-9-CM manual.
2.2 Describe how to use Volumes 1 and 2 to determine diagnosis codes.
2.3 Define the conventions used in Volumes 1 and 2 that help coders identify correct diagnosis codes.
2.4 Discuss general outpatient coding principles to select appropriate diagnosis codes.
Key TermsAlphabetic Index of Diseases
NEC (not elsewhere classifiable)
NOS (not otherwise specified)
Table of Drugs and Chemicals
Tabular List of Diseases (Volume 1)
Learning Outcomes After completing this chapter, students should be able to:
INTRODUCTION TO ICD9CM2
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CHAPTER 2 | INTRODUCTION TO ICD9CM 37
IntroductionDescribing medical services completely requires the use of at least two out of three separate coding systems. Two coding systemsCurrent Procedural Terminology (CPT) and Healthcare Common Procedural Coding System (HCPCS)describe the actual services provided and are discussed in later chapters of this book. A third system, the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM or ICD-9), describes the reasons those services were pro-vided. These three coding systems can be thought of as the what and the why regarding the services provided.
The ICD-9-CM coding system is based on the official version of the World Health Organizations (WHO) ninth revision of the International Classification of Diseases (ICD-9). The World Health Organization no longer maintains ICD-9, publishing instead the ICD-10. Two federal agenciesthe National Center for Health Statistics and the Cen ters for Medicare and Medicaid Servicesmaintain ICD-9-CM through the ICD-9-CM Coordination and Maintenance Committee, which publishes annual updates of the ICD-9-CM manual in October of each year. These two entities are responsible for converting the ICD-9-CM coding system to two new systems, ICD-10-CM (Diagnoses) and ICD-10-PCS (Procedures), scheduled to begin on October 1, 2013.
Correct diagnosis coding facilitates payment for services, tracks disease and associ-ated healthcare usage, advances research, and aids patient care. Diagnosis codes should be reported to the highest level of specificity known and accurately represent informa-tion in the medical record. It is important to review the medical record sufficiently to ascertain all the conditions treated. The ICD-9-CM diagnosis codes support the medi-cal necessity of the treatments provided to the patient.
Reporting diagnosis codes will change significantly in 2013 when the ICD-10-CM code set replaces the ICD-9-CM codes. ICD-10-CM will be discussed in detail in Chapter 5. Some instructors may choose to teach ICD-9-CM and ICD-10-CM together, whereas others may separate the two. To accommodate multiple approaches to learn-ing the current coding system as well as the future codes, exercises in Chapters 3 and 4 will include answers for both.
Many payers have claim edits in their adjudication (claims processing) systems that establish diagnosis to procedure code relationships to justify payments for the claimed procedure. Coders should be familiar with the specific requirements for each payer. When preparing a claim, review all diagnosis codes associated with the patient and visit to make sure that important information for reporting the particular service is not overlooked.
2.1 The Structure of the ICD-9-CM ManualThe ICD-9-CM code manual consists of three volumes. Volume 1 (Tabular List of Diseases) and Volume 2 (Alphabetic Index of Diseases) are used together to deter-mine appropriate diagnosis codes. These codes are used to report diagnoses in all settings. Volume 3, which contains both a tabular and alphabetical list of procedure codes, is used by hospitals to identify procedures performed on patients in their facilities. Physicians and other professionals do not use Volume 3 to report procedures.
Each volume is divided into chapters, tables, or appendices. The chapters in Volume 1 cover codes describing specific diseases and conditions. Volume 2 includes several
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38 PART I | ICD9CM AND ICD10CM CPT only 2010 American Medical Association. All rights reserved.
tables with information necessary to identify codes describing particular conditions. Chapters in Volume 3 describe procedures on specific body systems. Each of these is discussed in more detail below.
Coders must understand the basic structure of the ICD-9-CM manual and the informa-tion included in each volume. It is also important to understand which volumes are used to report diagnosis and procedure codes in each healthcare setting.
Also available in
Use the ICD-9-CM manual to answer the following questions.
1. How many volumes are included in the ICD-9-CM manual?
2. Identify the volumes by name and number.
3. Which healthcare entities use the codes in Volume 3?
2.2 Using Volumes 1 and 2 to Determine Diagnosis CodesVolume 1 is the Tabular List of Diseases. Volume 2 is the Alphabetic Index of Diseases. Coders use both volumes in tandem to determine correct diagnosis codes. When selecting a code to describe a diagnosis, coders actually use the Alphabetic Index in Volume 2 first to identify possible diagnosis codes, and then use the list of individual codes and their descriptors in Volume 1 to select the most appropriate code from among them. Because coders should always use the volumes in this order, Volume 2 is presented first, then Volume 1.
Volume 2: Alphabetic Index of Diseases The Alphabetic Index of Diseases lists diseases, conditions, and injuries along with their accompanying codes. It is used as a guide in finding the correct codes. In most manuals, Volume 2 actually precedes Volume 1, and the two volumes are al-ways used together to validate or refine the code selection. Volume 2 has three discrete sections:
Section 1: Alphabetic Index to diseases, conditions and injuries. This section includes the Hypertension Table and Neoplasm Table, which coders use to select the correct codes to describe related conditions. Figure 2.1 shows an example of entries in the Alphabetic Index.
Section 2: Table of Drugs and Chemicals, which includes an extensive list of drugs, industrial solvents, corrosive gases, noxious plants, pesticides, and other toxic agents. Coders use this table to identify poisonings and external causes of adverse affects.
Section 3: Alphabetic Index to External Causes of Injury and Poisoning (E-codes), a list of codes and terms that describe environmental circumstances, such as acci-dents or acts of violence, and other conditions that may be the cause of injury or other adverse effects.
Tabular List of Diseases (Volume 1)Volume 1 of the ICD-9-CM manual, which covers codes describing specific diseases and conditions.
Alphabetic Index of Diseases (Volume 2)Volume 2 of the ICD-9-CM manual, which includes several tables with information neces-sary to identify codes describ-ing particular conditions.
When assigning codes for neoplasms, begin with the Neoplasm Table that appears in Volume 2 of the ICD-9-CM manual.
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CHAPTER 2 | INTRODUCTION TO ICD9CM 39
Diagnosis codes that identify the main reason for the encounter should be listed first. When coding for professional medical services such as ophthalmology (rather than physician visits), usually referred to as outpatient coding, the major diagnosis is usually referred to as the first-listed diagnosis. For hospital coding, the major diag-nosis is often referred to as the principal diagnosis. Because this text primarily ad-dresses outpatient coding, the main diagnosis will be referred to as the first-listed diagnosis. Additional or secondary diagnosis codes may be listed to identify other conditions that are present.
hypertension tableA table containing a complete list of all conditions that are either due to or associated with hypertension.
neoplasm tableA table used to select correct codes for neoplasms.
table of drugs and chemicalsA table that includes an exten-sive list of drugs, industrial sol-vents, corrosive gases, noxious plants, pesticides, and other toxic agents to identify poison-ings and external causes of adverse af