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ICD-9-CM Coding Guidelines

ICD-9-CM Coding GuidelinesPresented by Cheryl Crosswhite, CPCAlthough ICD-10 is coming, and we should all be getting geared up for that change, we still live in the world of ICD-9. As such, I thought we could brush up on our skills a little.1 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

ICD-9-CM Official Guidelines for Coding and ReportingI hope no one has wasted money on new books for 2012, 2013.2

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.HIPAA Alert!It is amazing to me the carriers (FEP, federal carriers) that are still non-compliant with federal regulations.

4Four Sections:- Section I- Section II- Section III - Section IVOfficial Guidelines for Coding & ReportingSection I includes the structure and conventions of the classification and general guidelines that apply to the entire classification, and chapter-specific guidelines that correspond to the chapters as they are arranged in the classification. II includes guidelines for selection of principal diagnosis for non-outpatient settings, Section III includes guidelines for reporting additional diagnoses in non-outpatient settings. Section IV is for outpatient coding and reporting. 5Use 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.General GuidelinesIm not going to spend a lot of time on the general coding guidelines, as we are all pretty familiar with them.

6Signs 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.GuidelinesMultiple coding- Use additional code- Code first- If applicable, code any causal condition firstAcute (or subacute) and chronic conditionsCombination code versus multiple codeGuidelinesResidual condition that develops after acute phase of illness or injury has ended- No time limit on reportingFor 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)

Late EffectIn most instances, two codes will be assigned, one for the residual that is being treated and one code that indicates the late effect. There is no time limit for the development of a residual. It may be evident at the time of the acute illness or it may occur months after an injury.The residual is coded first, then the late effects code is assigned to indicate the cause of the residual. 9Principal diagnosisPrincipal procedureSecondary diagnosesSecondary proceduresFirst-listed diagnosisChapter-Specific Guidelines001-139OrganismsInfectionsSupplemental Classification of Factors Influencing Health Status and Contact with Health ServicesHuman immunodeficiency virus (HIV)Chapter 1: Infectious and Parasitic DiseasesBecause infectious or parasitic conditions can affect various parts of the body, this chapter contains a wide variety of codes. In this chapter there are many instances of combination coding and multiple coding. 11Key terms:- HIV disease- HIV infection- HIV infected- HIV positive- Acquired immune deficiency syndrome (AIDS)HIV Positive StatusCan only code CONFIRMED cases of HIV. This is an exception to the hospital inpatient guideline that states they can code probable, suspected, likely, questionable, possible, conditions. In this context, confirmation does NOT require documentation of a positive serology or culture for HIV, the providers diagnostic statement that the patient is HIV positive or has an HIV related illness is sufficient. 12140-239Neoplasm- New growths or tumors in which cell reproduction is out of control

BenignMalignantChapter 2: NeoplasmsSix classifications:- Primary malignancy- Secondary malignancy- Carcinoma (CA) in situ- Benign- Uncertain behavior- Unspecified natureChapter 2: NeoplasmsCarcinoma in situ is an early form of cancer that hasnt invaded any additional organ or surrounding tissue.

Uncertain behavior (235-238) classify by site certain histomorphologically well defined neoplasms the subsequent behavior of which cannot be predicted from the present appearance. Usually means pathology cannot determin whether it is malignant or not.

Unspecified nature (239), unspecified morphology and behavior (provider cannot determine by appearance whether it is malignant or not).14Contiguous sites (overlapping sites)Re-excision of tumorsChapter 2: Neoplasms240-279Diabetes mellitus- Type I: Patients body unable to produce insulin

- Type II:Patients body unable to properly use insulin producedChapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders280-289HematopoiesisAnemiaRed cell volumeHemoglobin contentShape (morphology)PurpuraChapter 4: Diseases of the Blood and Blood-Forming Organs290-319WHO 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 DisordersWHO Guidelines:- When coding mental illnesses associated with physical conditions, assign as many codes as necessary to fully describe the clinical picture.Chapter 5: Mental Disorders320-389Nervous system, including meningesCentral nervous system- Brain- Spinal cordPeripheral nervous systemChapter 6: Nervous System and Sense Organs390-459Hypertension, hypertensive table- Malignant (accelerated)- Benign- UnspecifiedCerebral infarction, stroke, CVALate effects of cerebrovascular diseaseMyocardial infarctionChapter 7: Circulatory System460-519Nose, sinuses, pharynx, larynx, trachea, bronchi, and lungsChronic obstructive pulmonary disease- Refer to main term obstructionPneumoniaAsthma (status asthmaticus)Acute exacerbationChapter 8: Respiratory System520-579Major digestive organs include pharynx, esophagus, stomach, and intestinesAccessory (secondary) organs include salivary and parotid glands, jaw, and teethStructures that support the digestive process are gallbladder, pancreas, and liverChapter 9: Digestive System580-629Chronic kidney disease (CKD)Kidney transplant status (V42.0)CKD with other conditionsChapter 10: Genitourinary System630-677Conditions occurring during pregnancy, childbirth, and six weeks immediately following childbirthNever report these codes on babys recordOutcome of delivery (V27.0-V27.9Chapter 11: Pregnancy, Childbirth, and Puerperium630-633 (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 Puerperium640-648 (complications related to pregnancy)650 (normal delivery)- Minimal or no assistance- Episiotomy permitted- Fetal manipulation (e.g., use of forceps) not permittedChapter 11: Pregnancy, Childbirth, and PuerperiumFifth 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 11: Pregnancy, Childbirth, and Puerperium680-709Epidermis, dermis, subcutaneous tissue, nails, sebaceous glands, sweat glands, hair, and hair folliclesChapter 12: Skin and Subcutaneous Tissue710-739Bones, muscles, cartilage, fascia, ligaments, synovia, tendons, and bursaLocalized osteoarthrosis- Primary, unknown etiology- Secondary, caused by external or internal injuryChapter 13: Musculoskeletal System and Connective Tissue740-759Classifies all conditions according to a principal or defining defect rather than cause- Except for chromosome abnormalitiesMay be apparent at birth or hidden and identified sometime after birthCodes may be used throughout patients lifeChapter 14: Congenital Anomalies760-779Perinatal period- Interval of time before, during, and up to 28 days following birthNEVER report these codes for the mothers episode of careChapter 15: Conditions Originating in Perinatal Period780-799Includes symptoms, signs and abnormal results of laboratory or other investigative proceduresChapter 16: Symptoms, Signs, Ill-Defined ConditionsKey terms:- Abnormal, abnormality- Decrease, decreased- Elevation- Findings, abnormal, without diagnosisChapter 16: Symptoms, Signs, Ill-Defined Conditions800-999InjuriesFracturesBurnsAdverse effects, poisonings, and toxic effectsChapter 17: Injury and PoisoningOpen/Compound fractureClosed/Simple fracture- Comminuted- Depressed- Fissured- Greenstick- ImpactedFracturesClosed/Simple fracture- Linear- Slipped epiphysis- Spiral fractureComplicatedMalunion (late effect)Fractures940-949Classified according to:- DepthFirst degree (erythema)Second degree (blistering)Third degree (full thickness)- ExtentPercentage of body surface- Agent (e.g., chemicals, fire, sun)E Codes assignedBurnsAdverse 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 ChemicalsAdverse Effects, Poisonings, and Toxic EffectsOccurs 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 codeinePoisoning960-979Manifestation of poisoningAccidental (E850-E869)Suicide attempt (E950-E952)Assault (E961-E962)Undetermined (E980-E982)PoisoningWhen someone ingests or comes into contact with a harmful substanceToxic EffectsV01-V85Supplementary Classification of Factors Influencing Health Status and contact with Health ServicesClassifies occasions when circumstances other than disease or injury are recorded as diagnoses or problemsV CodesCategories:- Contact/Exposure- Inoculations and vaccinations- Status- History (of)- Screening- Observation- AftercareV CodesCategories, cont.- Follow-up- Donor- Counseling- Obstetrics and related conditions- Newborn, infant, and child- Routine and administrative examinations- MiscellaneousV CodesE800-E999Supplemental Classification of External Causes of Injury and PoisoningClassifies environmental events, circumstances, and conditions as cause of injury, poisoning, or other adverse effectE CodesReported in addition to a code from Chapters 1-17 to indicate nature of conditionMachinery accidents (E919)Late effects of accidents (E929, E959, E969, E977, E989, E999)Transport accidents (E800-E848)E CodesPlace of occurrence (E849)- Describes place where event occurred, NOT patients activity at the timeE Codes


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