CHAPER 4: ICD-9-CM CODING GUIDELINES

Report
Chapter 4
ICD-9-CM Coding
Guidelines
© 2010 Delmar, Cengage Learning
ICD-9-CM Official Guidelines for
Coding and Reporting
• Rules developed by the cooperating parties
for the ICD-9-CM to accompany and
complement the official conventions and
instructions provided within ICD-9-CM
• Companion to ICD-9-CM
© 2010 Delmar, Cengage Learning
(continued)
ICD-9-CM Official Guidelines for
Coding and Reporting
• Cooperating parties consist of:
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American Hospital Association (AHA)
AHIMA
CMS
NCHS
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HIPAA Alert!
• 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.
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Official Guidelines for Coding and
Reporting
• Four sections:
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Section I
Section II
Section III
Section IV
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Historical Perspective
• Bertillon International Statistical
Classification of Causes of Death
• International Classification of Diseases
(ICD)
• ICD-9-CM
• ICD-10-CM and ICD-10-PCS (future)
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General Guidelines
• Use 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.
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Guidelines
• Signs 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.
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(continued)
Guidelines
• Multiple coding
– Use additional code
– Code first
– If applicable, code any causal condition first
• Acute (or subacute) and chronic conditions
• Combination code versus multiple code
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Late Effect
• Residual condition that develops after acute
phase of illness or injury has ended
– No time limit on reporting
• Combination code assigned
• For example, painful cicatrix following severe
burn to the elbow or left-sided paralysis due
to previous cerebrovascular accident (CVA)
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General Procedure Guidelines
• Based on anatomy rather than surgical
specialty
• Numeric codes
• Use both Index to Procedures and Tabular
List of Procedures
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(continued)
General Procedure Guidelines
• Index to Procedures main terms organized
in alphabetic order according to type of
procedure
• Report codes using highest number of digits
available
• — omit code
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(continued)
General Procedure Guidelines
• Common key terms:
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Application
Closure
Correction
Destruction
Division
Incision
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Insertion
Operation
Procedure
Release
Removal
Repair
(continued)
General Procedure Guidelines
• Common key terms:
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Resection
Revision
Suture
Test
Therapy
Transfer
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(continued)
General Procedure Guidelines
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Combination codes
Multiple codes
And/Or
Open procedure versus closed procedure
Endoscopic procedures
Biopsies
Canceled surgery
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Chapter-Specific Guidelines
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Principal diagnosis
Principal procedure
Secondary diagnoses
Secondary procedures
First-listed diagnosis
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Chapter 1: Infectious and Parasitic
Diseases
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001–139
Organisms
Infections
“Supplemental Classification of Factors
Influencing Health Status and Contact with
Health Services”
• Human immunodeficiency virus (HIV)
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HIV Positive Status
• Key terms:
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HIV disease
HIV infection
HIV infected
HIV positive
Acquired immune deficiency syndrome (AIDS)
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HIV
• HIV-related conditions and opportunistic
infections
• Sequence HIV code (042) first and then
opportunistic infection code
• Sequencing of HIV codes with admission
for unrelated condition
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(continued)
HIV
• Asymptomatic HIV
• Inconclusive HIV serology
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Chapter 2: Neoplasms
• 140–239
• Neoplasm
– “New growths or tumors in which cell reproduction is
out of control”
• Benign
• Malignant
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(continued)
Chapter 2: Neoplasms
• Six classifications:
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Primary malignancy
Secondary malignancy
Carcinoma (CA) in situ
Benign
Uncertain behavior
Unspecified nature
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(continued)
Chapter 2: Neoplasms
• Contiguous sites (overlapping sites)
• Re-excision of tumors
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Chapter 3: Endocrine, Nutritional, and
Metabolic Diseases and Immunity Disorders
• 240–279
• Diabetes mellitus
– Type I
• Patient’s body unable to produce insulin
– Type II
• Patient’s body unable to properly use insulin produced
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Chapter 4: Diseases of the Blood and
Blood-Forming Organs
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280–289
Hematopoiesis
Anemia
Red cell volume
Hemoglobin content
Shape (morphology)
Purpura
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Chapter 5: Mental Disorders
• 290–319
• WHO 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.
© 2010 Delmar, Cengage Learning
(continued)
Chapter 5: Mental Disorders
• WHO guidelines:
– When coding mental illnesses associated with physical
conditions, assign as many codes as necessary to fully
describe the clinical picture.
© 2010 Delmar, Cengage Learning
Chapter 6: Nervous System and
Sense Organs
• 320–389
• Nervous system, including meninges
• Central nervous system
– Brain
– Spinal cord
• Peripheral nervous system
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Chapter 7: Circulatory System
• 390–459
• Hypertension, hypertensive table
– Malignant (accelerated)
– Benign
– Unspecified
• Cerebral infarction, stroke, CVA
• Late effects of cerebrovascular disease
• Myocardial infarction
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Chapter 8: Respiratory System
• 460–519
• Nose, sinuses, pharynx, larynx, trachea,
bronchi, and lungs
• Chronic obstructive pulmonary disease
– Refer to main term “obstruction”
• Pneumonia
• Asthma (status asthmaticus)
• Acute exacerbation
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Chapter 9: Digestive System
• 520–579
• Major digestive organs include pharynx,
esophagus, stomach, and intestines
• Accessory (secondary) organs include
salivary and parotid glands, jaw, and teeth
• Structures that support the digestive process
are gallbladder, pancreas, and liver
© 2010 Delmar, Cengage Learning
Chapter 10: Genitourinary System
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580–629
Chronic kidney disease (CKD)
Kidney transplant status (V42.0)
CKD with other conditions
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Chapter 11: Pregnancy, Childbirth,
and Puerperium
• 630–677
• Conditions occurring during pregnancy,
childbirth, and six weeks immediately
following childbirth
• Never report these codes on baby’s record
• Outcome of delivery (V27.0–V27.9)
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(continued)
Chapter 11: Pregnancy, Childbirth,
and Puerperium
• 630–633 (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)
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(continued)
Chapter 11: Pregnancy, Childbirth,
and Puerperium
• 640–648 (complications related to
pregnancy)
• 650 (normal delivery)
– Minimal or no assistance
– Episiotomy permitted
– Fetal manipulation (e.g., use of forceps) not permitted
© 2010 Delmar, Cengage Learning
(continued)
Chapter 11: Pregnancy, Childbirth,
and Puerperium
• Fifth 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)
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Chapter 12: Skin and Subcutaneous
Tissue
• 680–709
• Epidermis, dermis, subcutaneous tissue,
nails, sebaceous glands, sweat glands, hair,
and hair follicles
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Chapter 13: Musculoskeletal System
and Connective Tissue
• 710–739
• Bones, muscles, cartilage, fascia, ligaments,
synovia, tendons, and bursa
• Localized osteoarthrosis
– Primary
• Unknown etiology
– Secondary
• Caused by external or internal injury
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Chapter 14: Congenital Anomalies
• 740–759
• Classifies all conditions according to a
principal or defining defect rather than cause
– Except for chromosome abnormalities
• May be apparent at birth or hidden and
identified sometime after birth
• Codes may used throughout patient’s life
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Chapter 15: Conditions Originating in
Perinatal Period
• 760–779
• Perinatal period
– Interval of time before, during, and up to 28 days
following birth
• Never report these codes for the mother’s
episode of care
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Chapter 16: Symptoms, Signs, IllDefined Conditions
• 780–799
• Includes symptoms, signs, and abnormal
results of laboratory or other investigative
procedures
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(continued)
Chapter 16: Symptoms, Signs, IllDefined Conditions
• Key terms:
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Abnormal, abnormality
Decrease, decreased
Elevation
Findings, abnormal, without diagnosis
© 2010 Delmar, Cengage Learning
Chapter 17: Injury and Poisoning
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800–999
Injuries
Fractures
Burns
Adverse effects, poisonings, and toxic
effects
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Fractures
• Open/Compound fracture
• Closed/Simple fracture
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Comminuted
Depressed
Fissured
Greenstick
Impacted
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(continued)
Fractures
• Closed/Simple fracture
– Linear
– Slipped epiphysis
– Spiral fracture
• Complicated
• Malunion (late effect)
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Burns
• 940–949
• Classified according to:
– Depth
• First degree (erythema)
• Second degree (blistering)
• Third degree (full thickness)
– Extent
• Percentage of body surface
– Agent (e.g., chemicals, fire, sun)
• E codes assigned
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Adverse Effects, Poisonings, and
Toxic Effects
• Adverse 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 Chemicals
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Poisoning
• Occurs as result of overdose
• Wrong substance administered or taken or
intoxication that involves combining
prescribed drugs with nonprescribed drugs
or alcohol
• For example, coma due to overdose of
codeine
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(continued)
Poisoning
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960–979
Manifestation of poisoning
Accidental (E850–E869)
Suicide attempt (E950–E952)
Assault (E961–E962)
Undetermined (E980–E982)
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Toxic Effects
• When someone ingests or comes into
contact with a harmful substance
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V Codes
• (V01–V85)
• Supplementary Classification of Factors
Influencing Health Status and Contact with
Health Services
• Classifies occasions when circumstances
other than disease or injury are recorded as
diagnoses or problems
© 2010 Delmar, Cengage Learning
(continued)
V Codes
• Categories:
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Contact/Exposure
Inoculations and vaccinations
Status
History (of)
Screening
Observation
Aftercare
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(continued)
V Codes
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Follow-up
Donor
Counseling
Obstetrics and related conditions
Newborn, infant, and child
Routine and administrative examinations
Miscellaneous
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E Codes
• (E800–E999)
• Supplemental Classification of External
Causes of Injury and Poisoning
• Classifies environmental events,
circumstances, and conditions as cause of
injury, poisoning, or other adverse effect
© 2010 Delmar, Cengage Learning
(continued)
E Codes
• Reported in addition to a code from
Chapters 1–17 to indicate nature of
condition
• Machinery accidents (E919)
• Late effects of accidents (E929, E959,
E969, E977, E989, E999)
• Transport accidents (E800–E848)
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(continued)
E Codes
• Place of occurrence (E849)
– Describes place where event occurred
• Not patient’s activity at the time
© 2010 Delmar, Cengage Learning

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