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Introduction to ICD-9-CM Introduction to ICD-9-CM Introduction to ICD-9-CM

Introduction to ICD-9-CM. Review the layout of the ICD-9-CM Understand conventions Master the code look-up process Discuss Official ICD-9-CM Coding Guidelines

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  • Slide 1
  • Introduction to ICD-9-CM
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  • Review the layout of the ICD-9-CM Understand conventions Master the code look-up process Discuss Official ICD-9-CM Coding Guidelines Objectives 2
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  • Introduction to ICD-9-CM International Classification of Disease, Ninth Revision, Clinical Modification Modified for use in the United States Describes in detail the patients condition Uses Statistical aggregation within populations Reporting medical necessity to insurers Introduction to ICD-9-CM 3
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  • Find these features Volume 1 Volume 2 Coding Guidelines Look at Your Code Book 4
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  • Introduction to ICD-9-CM Rhinoplasty: nose job Repair an injury? Improve cosmetic appearance? Was the service covered under the patients medical policy? Is the service medically necessary? Medical Necessity 5
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  • Introduction to ICD-9-CM Rules to make lookup more efficient ICD-9-CM Coding Conventions 6
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  • Introduction to ICD-9-CM History (personal) of abuse emotional V15.42 neglect V15.42 physical V15.41 sexual V15.41 affective psychosis V11.1 alcoholism V11.3 specified as drinking problem (see also abuse, drugs, nondependent) 305.0x Index: History (Personal) 7
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  • Introduction to ICD-9-CM failed conscious sedation V15.80 moderate sedation V15.80 falling V15.88 family allergy V19.6 anemia V18.2 arteriosclerosis V17.49 Index: History (Personal) 8
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  • Introduction to ICD-9-CM failed conscious sedation V15.80 moderate sedation V15.80 falling V15.88 family allergy V19.6 anemia V18.2 arteriosclerosis V17.49 Index: History (Personal) 9
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  • Introduction to ICD-9-CM NEC Not elsewhere classifiable We know whats wrong, but there isnt a specific code for it. NOS Not otherwise specified We arent sure whats wrong. NEC vs. NOS 10
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  • Introduction to ICD-9-CM [ ] Brackets: in tabular enclose synonyms or alternate wording Example: 521.7 Intrinsic posteruptive color changes Staining [discoloration] of teeth [ ] Slanted brackets: in index identifies manifestations and indicates sequence. Example: Diabetes gangrene 250.7x [785.4] Punctuation 11
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  • Introduction to ICD-9-CM ( ) Parentheses: enclose supplementary words that may be present in the description Example: Blindness (acquired)(congenital)(both eyes) Punctuation 12
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  • Introduction to ICD-9-CM 232 Carcinoma in situ of skin pigment cells melanoma in situ of skin (172.0-172.9) 232.5 Skin of trunk, except scrotum Anus, margin Axillary fold Perianal skin Skin of: abdominal wall Additional Terms 13 Includes Excludes
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  • Introduction to ICD-9-CM Diabetes gangrene 250.7x [785.4] 250.7 Diabetes with peripheral circulatory disorders Use additional code to identify manifestation, as: diabetic gangrene (785.4) peripheral angiopathy (443.81) Use additional code 14
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  • Introduction to ICD-9-CM 422.0 Acute myocarditis in diseases classified elsewhere Code first underlying diseases, as: myocarditis (acute): influenzal (487.8, 488.09, 488.19) tuberculous (017.9) Code first 15
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  • Introduction to ICD-9-CM 692.3 Contact dermatitis due to drugs and medicines in contact with skin Use additional E code to identify drug Use Additional Code 16
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  • Introduction to ICD-9-CM 571.5 Cirrhosis of liver without mention of alcohol Code first, if applicable, viral hepatitis (acute) (chronic) (070.0-070.9) Use Additional Code, if Applicable 17
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  • Introduction to ICD-9-CM Single codes: 780.52 Insomnia, unspecified 780.57 Unspecified sleep apnea Combination code: 780.51 Insomnia with sleep apnea, unspecified Combination Codes 18
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  • Introduction to ICD-9-CM Find the documented diagnosis Determine the main term Look up the main term in the Index to Diseases (Volume 2) Find the code in the Tabular List (Volume 1) Read all notes associated with the code Steps to Look Up a Diagnosis Code 19
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  • Introduction to ICD-9-CM What is the: disease? illness? symptom? Example: Acute purulent viral bronchitis Severe unremitting pain in the right leg Main Term 20
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  • Introduction to ICD-9-CM Ruptured ovarian cyst Decubitus ulcer of the right heel Congenital absence of ear lobe Febrile convulsions Whats the Main Term? 21
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  • Introduction to ICD-9-CM Ruptured ovarian cyst Decubitus ulcer of the right heel Congenital absence of ear lobe Febrile convulsions Whats the Main Term? 22
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  • Introduction to ICD-9-CM Locate term in index Note code associated with chosen index entry Lookup code in tabular section Tabular section 17 chapters Chapters have 3-digit categories Categories have 4- or 5-digit subcategories Code Lookup 23
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  • Introduction to ICD-9-CM 123 M&Ms 1 Chocolate filled 2 Peanut filled 1 Red 2 Blue 3 Yellow 4 Green 5 Brown 9 Unspecified Specificity 24 123.2x M&M; Peanut filled 123.11 M&M; Chocolate filled; Red 123.23 M&M; Peanut filled; Yellow
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  • Introduction to ICD-9-CM Scientific Classification 25 Chapter: Overarching scientific classification: CANDY Three-digit category within chapter: M&M Four-digit category within chapter: PEANUT Five Digit category: RED
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  • Introduction to ICD-9-CM 824 Fracture of ankle 824.0 Medial malleolus, closed 824.1 Medial malleolus, open 824.2 Lateral malleolus, closed 824.3 Lateral malleolus, open 824.4 Bimalleolar, closed 824.5 Bilmalleolar, open 824.6 Trimalleolar, closed 824.7 Trimalleolar, open 824.8 Unspecified, closed 824.9 Unspecified, open 042 AIDS Ankle fracture vs AIDS 26
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  • Introduction to ICD-9-CM Scientific Classification 27 Chapter: Signs and Symptoms 788 Symptoms involving urinary system 788.3 Urinary incontinence 788.32 Stress incontinence, male
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  • Introduction to ICD-9-CM Complicated Open Wound of Nasal Sinus 28 Chapter: Injury and poisoning 873 Other open wound of head 873.3 Nose, complicated 873.33 Nasal sinus
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  • Introduction to ICD-9-CM Arthritis, arthritic (acute) (chronic) (subacute) 716.9 meaning Osteoarthritis see Osteoarthrosis Note: Use the following fifth digit subclassifications with categories 711-712, 715-716 0site unspecified 1shoulder region 2upper arm 3forearm 4hand 5pelvic 6lower leg 7ankle and foot 8other specified sites 9multiple sites Acute Arthritis 29 5 th
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  • Introduction to ICD-9-CM 716.9 Arthropathy, unspecified [0-9]Arthritis (acute) (chronic) (subacute) Arthropathy (acute) (chronic) (subacute) Articular rheumatism (chronic) Inflammation of joint NOS Acute Arthritis 30 5 th
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  • Introduction to ICD-9-CM The following fifth-digit subclassification is for use with category 716; valid digits are in [brackets] under each code. See the list at beginning of chapter for definitions. 0 site unspecified 1 shoulder region 2 upper arm 3 forearm 4 hand 5 pelvis region and thigh 6 lower leg 7 ankle and foot 8 other specified sites 9 multiple sites Acute Arthritis 31
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  • Introduction to ICD-9-CM Section 1 A: Coding conventions B: Coding guidelines C: Chapter-specific guidelines ICD-9-CM Official Guidelines for Coding and Reporting 32 www.cdc.gov/nchs/data/icd9/icdguide10.pdf
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  • Introduction to ICD-9-CM Reference: I.C.8.a.1. Section I. Conventions, general coding guidelines and chapter specific guidelines ICD-9-CM Official Guidelines for Coding and Reporting 33 www.cdc.gov/nchs/data/icd9/icdguide10.pdf
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  • Introduction to ICD-9-CM Reference: I.C.8.a.1. Section I. Conventions, general coding guidelines and chapter specific guidelines C. Chapter-Specific Coding Guidelines ICD-9-CM Official Guidelines for Coding and Reporting 34 www.cdc.gov/nchs/data/icd9/icdguide10.pdf
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  • Introduction to ICD-9-CM Reference: I.C.8.a.1. Section I. Conventions, general coding guidelines and chapter specific guidelines C. Chapter-Specific Coding Guidelines 8. Chapter 8: Diseases of the Respiratory System (460- 519) ICD-9-CM Official Guidelines for Coding and Reporting 35 www.cdc.gov/nchs/data/icd9/icdguide10.pdf
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  • Introduction to ICD-9-CM Reference: I.C.8.a.1. Section I. Conventions, general coding guidelines and chapter specific guidelines C. Chapter-Specific Coding Guidelines 8. Chapter 8: Diseases of the Respiratory System (460- 519) a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma ICD-9-CM Official Guidelines for Coding and Reporting 36 www.cdc.gov/nchs/data/icd9/icdguide10.pdf
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  • Introduction to ICD-9-CM Reference: I.C.8.a.1. Section I. Conventions, general coding guidelines and chapter specific guidelines C. Chapter-Specific Coding Guidelines 8. Chapter 8: Diseases of the Respiratory System (460- 519) a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma 1) Conditions that comprise COPD and Asthma ICD-9-CM Official Guidelines for Coding and Reporting 37 www.cdc.gov/nchs/data/icd9/icdguide10.pdf
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  • Introduction to ICD-9-CM Section 1 A: Coding conventions B: Coding guidelines C: Chapter-specific guidelines Sections 2 & 3 Inpatient Only ICD-9-CM Official Guidelines for Coding and Reporting 38 www.cdc.gov/nchs/data/icd9/icdguide10.pdf
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  • Introduction to ICD-9-CM Section 1 A: Coding conventions B: Coding guidelines C: Chapter-specific guidelines Sections 2 & 3 Inpatient Only Section 4 UHDDS guidelines for first listed conditions for outpatient and office visits ICD-9-CM Official Guidelines for Coding and Reporting 39 www.cdc.gov/nchs/data/icd9/icdguide10.pdf
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  • Introduction to ICD-9-CM 1. Always follow instructions within ICD-9-CM that are specific to the code. 2. Follow chapter or section instructions when they do not conflict with the individual code instructions. 3. Follow guidelines when they do not conflict with the chapter, section, or individual code instructions. ICD-9-CM Guidelines Hierarchy of Rules 40
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  • Introduction to ICD-9-CM Inpatient hospital Hospitality: nursing care, bed, OR, tests, meds Payment for level of hospitality required Outpatient physician Surgical procedures and office visits Payment for services rendered ICD-9-CM Guidelines 41
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  • Introduction to ICD-9-CM 1.Use of Both Alphabetic Index and Tabular List 2.Locate each term in the Alphabetic Index and Tabular List 3.Level of Detail in Coding 4.Code or codes from 001.0 through V91.99 5.Selection of codes 001.0 through 999.9 General Coding Guidelines: Section I. B. 42
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  • Introduction to ICD-9-CM 6.Signs and symptoms 7.Conditions that are an integral part of the disease process 8.Conditions that are not an integral part of the disease process 9.Multiple coding for a single condition General Coding Guidelines: Section I. B. 43
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  • Introduction to ICD-9-CM 10.Acute and Chronic conditions Acute Bronchitis 466.0 Chronic Bronchitis 491.9 Code both, acute first, then chronic466.0, 491.9 11.Combination code Right bundle branch block426.4 Left bundle branch block426.3 Other bilateral bundle branch block426.53 Code only the bilateral bundle branch block 426.53 General Coding Guidelines: Section I. B. 44
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  • Introduction to ICD-9-CM 12.Late Effects Code first the residual condition of the late effect Code second the cause for the late effect (905.0-909.9) 13.Impending or threatened conditions 14.Reporting same diagnosis more than once Right kidney infection 590.9 Left kidney infection590.9 Report code only once as 590.9 General Coding Guidelines: Section I. B. 45
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  • Introduction to ICD-9-CM 15.Admissions/encounters for rehabilitation V57.1 Other physical therapy 729.2Neuralgia, neuritis, and radiculitis 16.Documentation of BMI (Body Mass Index) and pressure ulcer stages 17.Syndromes General Coding Guidelines: Section I. B. 46
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  • Introduction to ICD-9-CM A.Selection of first-listed condition 1. Outpatient surgery 2. Observation stay Exception: Admit for surgery, develops complication, sent to observation: Reason for surgery is coded first Complication for observation is coded second Section IV: Diagnostic Coding and Reporting Guidelines for Outpatient Services 47
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  • Introduction to ICD-9-CM B.Codes from 001.0 through V91.99 C.Accurate reporting of ICD-9-CM diagnosis codes D.Selection of codes 001.0 through 999.9 E.Codes that describe symptoms and signs Section IV: Diagnostic Coding and Reporting Guidelines for Outpatient Services 48
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  • Introduction to ICD-9-CM F.Encounters for circumstances other than a disease or injury G.Encounters for circumstances other than a disease or injury Level of detail in coding Section IV: Diagnostic Coding and Reporting Guidelines for Outpatient Services 49 4 th 5 th
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  • Introduction to ICD-9-CM H.ICD-9-CM code for the diagnosis, condition, problem, or other reason for encounter/visit I.Uncertain diagnosis J.Chronic diseases K.Code all documented conditions that co-exist Section IV: Diagnostic Coding and Reporting Guidelines for Outpatient Services 50
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  • Introduction to ICD-9-CM L.Patients receiving diagnostic services only M.Patients receiving therapeutic services only Exception: primary reason for visit is chemotherapy, radiation therapy, or rehabilitation N.Patients receiving preoperative evaluations only Section IV: Diagnostic Coding and Reporting Guidelines for Outpatient Services 51
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  • Introduction to ICD-9-CM O.Ambulatory Surgery P.Routine outpatient prenatal visits Section IV: Diagnostic Coding and Reporting Guidelines for Outpatient Services 52
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  • Introduction to ICD-9-CM The End