ICD-9-CM Coding Guidelines
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Transcript ICD-9-CM Coding Guidelines
Presented by Cheryl Crosswhite, CPC
ICD-9-CM Official Guidelines for Coding
and Reporting
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
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.
Official Guidelines for
Coding & Reporting
Four Sections:
- Section I
- Section II
- Section III
- Section IV
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.
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.
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
Late Effect
Residual condition that develops after
acute phase of illness or injury has ended
- No time limit on reporting
For 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)
Chapter-Specific Guidelines
Principal diagnosis
Principal procedure
Secondary diagnoses
Secondary procedures
First-listed diagnosis
Chapter 1: Infectious and
Parasitic Diseases
001-139
Organisms
Infections
“Supplemental Classification of Factors
Influencing Health Status and Contact
with Health Services”
Human immunodeficiency virus (HIV)
HIV Positive Status
Key terms:
- HIV disease
- HIV infection
- HIV infected
- HIV positive
- Acquired immune deficiency syndrome (AIDS)
Chapter 2: Neoplasms
140-239
Neoplasm
- “New growths or tumors in which cell
reproduction is out of control”
Benign
Malignant
Chapter 2: Neoplasms
Six classifications:
- Primary malignancy
- Secondary malignancy
- Carcinoma (CA) in situ
- Benign
- Uncertain behavior
- Unspecified nature
Chapter 2: Neoplasms
Contiguous sites (overlapping
sites)
Re-excision of tumors
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
Chapter 4: Diseases of the Blood and
Blood-Forming Organs
280-289
Hematopoiesis
Anemia
Red cell volume
Hemoglobin content
Shape (morphology)
Purpura
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.
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.
Chapter 6: Nervous System
and Sense Organs
320-389
Nervous system, including meninges
Central nervous system
- Brain
- Spinal cord
Peripheral nervous system
Chapter 7: Circulatory System
390-459
Hypertension, hypertensive table
- Malignant (accelerated)
- Benign
- Unspecified
Cerebral infarction, stroke, CVA
Late effects of cerebrovascular disease
Myocardial infarction
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
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
Chapter 10: Genitourinary System
580-629
Chronic kidney disease (CKD)
Kidney transplant status (V42.0)
CKD with other conditions
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
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)
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
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)
Chapter 12: Skin and
Subcutaneous Tissue
680-709
Epidermis, dermis, subcutaneous
tissue, nails, sebaceous glands, sweat
glands, hair, and hair follicles
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
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 be used throughout patient’s life
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
Chapter 16: Symptoms, Signs, Ill-Defined
Conditions
780-799
Includes symptoms, signs and
abnormal results of laboratory or other
investigative procedures
Chapter 16: Symptoms, Signs, Ill-Defined
Conditions
Key terms:
- Abnormal, abnormality
- Decrease, decreased
- Elevation
- Findings, abnormal, without diagnosis
Chapter 17: Injury and
Poisoning
800-999
Injuries
Fractures
Burns
Adverse effects, poisonings, and toxic
effects
Fractures
Open/Compound fracture
Closed/Simple fracture
- Comminuted
- Depressed
- Fissured
- Greenstick
- Impacted
Fractures
Closed/Simple fracture
- Linear
- Slipped epiphysis
- Spiral fracture
Complicated
Malunion (late effect)
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
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
Poisoning
Occurs 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 codeine
Poisoning
960-979
Manifestation of poisoning
Accidental (E850-E869)
Suicide attempt (E950-E952)
Assault (E961-E962)
Undetermined (E980-E982)
Toxic Effects
When someone ingests or comes
into contact with a harmful
substance
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
V Codes
Categories:
- Contact/Exposure
- Inoculations and vaccinations
- Status
- History (of)
- Screening
- Observation
- Aftercare
V Codes
Categories, cont.
- Follow-up
- Donor
- Counseling
- Obstetrics and related conditions
- Newborn, infant, and child
- Routine and administrative examinations
- Miscellaneous
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
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)
E Codes
Place of occurrence (E849)
- Describes place where event
occurred, NOT patient’s activity at
the time