Intro to ICD-9 Coding

Nancy Clark, M.Ed.Director of Medical Informatics EducationFSU 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 InfoRetriever Epocrates ICD Bluefish RX ICD and C

PT CodeMeister ICD Notes Pocket ICD/CPT StatICD, StatE&M,

others ICD-9-CM pocket

Objectives

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

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

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 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 Do not code a diagnosis that is no longer applicable.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 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 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.

Anatomy of ICD-9 Code

Organization of ICD-9 Volume 1001-139 Infectious and Parasitic Diseases 140-239 Neoplasms240-279 Endocrine, Nutritional and Metabolic Diseases280-289 Diseases of the Blood and Blood-forming Organs290-319 Mental Disorders320-389 Diseases of the Nervous System and Sense Organs390-459 Diseases of the Circulatory System460-519 Diseases of the Respiratory System520-579 Diseases of the Digestive System580-589 Diseases of the Genitourinary System630-676 Complications of Pregnancy, Childbirth, and the

Puerperium680-709 Diseases of the Skin and Subcutaneous Tissue

Organization of ICD-9 Volume 1710-739 Diseases of the Musculoskeletal System &

Connective Tissue740-759 Congenital Anomalies760-779 Certain Conditions Originating in the Perinatal

Period780-799 Symptoms, Signs and Ill-defined Conditions800-999 Injury and PoisoningE800-E999 Supplementary Classification of the

External Causes of Injury and PoisoningV01-V82 Supplementary Classification of factors

influencing Health Status and Contact with Health Services

Key to Symbols

Additional Digits RequiredNonspecific CodeNot a Primary DiagnosisNot Elsewhere ClassifiedNot Otherwise Specified

NEC

NOS

EXCLUDES

INCLUDESSymbols may vary with different books.Look for Key at beginning of Volume 1.

Volume 1 Structure

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

Hypertension Neoplasms

Using Book

Look up first 3 digits in Volume 2 Indices Pain, Chest 786.5

Using Book

Turn to that ICD code in Volume 1 786.5 Chest pain

786.50 Chest pain, unspecified786.51 Precordial pain786.52 Painful respiration

Pain: Pleurodyniaanterior chest wallpleuritic

epidemic pleurodynia (074.1)

786.59 OtherDiscomfortPressure in chestTightness

EXCLUDES

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 466.0

New Acute or Chronic Problem that you can’t diagnose this visit

Code the symptom

Abdominal swelling or mass in epigastric area

789.36Elevated blood pressure

796.2

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 2Well Child v20.2 (EPSDT different)General Physical v70.0Gynecological exam v72.3

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

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 accidentFollow-up for pneumonia (fully

healed) v12.6

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

906.1

Chronic Problems with Sequelae

Requires two codes: Code the Chronic Problem first Code the Complication secondType 2 diabetic develops peripheral neuropathy

Type 2 DM with neurological manifestations 250.60 Peripheral neuropathy 337.1

Accidents, Suicides, Poisonings . . . External Causes

Use E codes and/or Injury and Poisoning Look up injury in Index, circumstances in

E-CodesElderly patient fell, sprained internal

collateral ligament in ankle while stepping from curb:

Sprains and strains of ankle and foot 845.01Fall on or from sidewalk curb E880.1

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 penicillinAllergic urticaria 708.0Penicillin poisoning 960.0Therapeutic 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 C

PT CodeMeister ICD Notes Pocket ICD/CPT StatICD, StatE&M

, others ICD-9-CM pocket

References and Resources

1. Sulkes, S. Coding and Documenting for Reimbursement. In: Coleman, W. (2001) Family Focused Behavioral Pediatrics. Lippincott Williams & Wilkins, Philadelphia, PA. Available at Books@OVID

Look up some diagnoses