Intro to ICD-9 Coding
Nancy Clark, M.Ed.
Director of Medical Informatics Education
FSU College of Medicine
Class Resources Needed
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ICD-9 Coding book
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Pages refer to
Medicode book. Page
numbers may not
match other books.
A medical reference
with ICD-9 codes
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Online ICD-9 coder
at CDC Wonder
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PDA Coding Programs
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InfoRetriever
Epocrates ICD
Bluefish RX ICD and
CPT
CodeMeister
ICD Notes
Pocket ICD/CPT
StatICD, StatE&M,
others
ICD-9-CM pocket
Objectives
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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
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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
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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
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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diagnosis that is no longer
applicable.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
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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
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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 1
001-139
140-239
240-279
280-289
290-319
320-389
390-459
460-519
520-579
580-589
630-676
680-709
Infectious and Parasitic Diseases
Neoplasms
Endocrine, Nutritional and Metabolic Diseases
Diseases of the Blood and Blood-forming
Organs
Mental Disorders
Diseases of the Nervous System and Sense
Organs
Diseases of the Circulatory System
Diseases of the Respiratory System
Diseases of the Digestive System
Diseases of the Genitourinary System
Complications of Pregnancy, Childbirth, and
the Puerperium
Diseases of the Skin and Subcutaneous Tissue
Organization of ICD-9 Volume 1
710-739 Diseases of the Musculoskeletal System &
Connective Tissue
740-759 Congenital Anomalies
760-779 Certain Conditions Originating in the Perinatal
Period
780-799 Symptoms, Signs and Ill-defined Conditions
800-999 Injury and Poisoning
E800-E999 Supplementary Classification of the
External Causes of Injury and Poisoning
V01-V82 Supplementary Classification of factors
influencing Health Status and Contact with
Health Services
Key to Symbols
NEC
NOS
Additional Digits Required
Nonspecific Code
Not a Primary Diagnosis
Not Elsewhere Classified
Not Otherwise Specified
EXCLUDES
INCLUDES
Symbols may vary with different books.
Look for Key at beginning of Volume 1.
Volume 1 Structure
ICD-9 Volume 2
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Section 1 - Alphabetic Index to Diseases
Section 2 - Table of Drugs and Chemicals
Section 3 - Index to External Causes
Handy Tables
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Hypertension
Neoplasms
Using Book
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Look up first 3 digits in Volume 2
Indices
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Pain, Chest 786.5
Using Book
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Turn to that ICD code in Volume 1
786.5
786.50
786.51
786.52
Chest pain
Chest pain, unspecified
Precordial pain
Painful respiration
Pain:
Pleurodynia
anterior chest wall
pleuritic
EXCLUDES
786.59
epidemic pleurodynia (074.1)
Other
Discomfort
Pressure
Tightness
in chest
New, Acute Problem, Diagnosable
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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
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Code the symptom
Abdominal swelling or mass in
epigastric area
789.36
Elevated 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 2
Well Child v20.2 (EPSDT different)
General Physical v70.0
Gynecological exam v72.3
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More on Annual Physicals
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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 accident
Follow-up for pneumonia (fully
healed)
v12.6
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Follow-up to Previous Acute
Problem, there are complications
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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 second
Type 2 diabetic develops peripheral neuropathy
Type 2 DM with neurological manifestations
250.60
Peripheral neuropathy 337.1
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Accidents, Suicides, Poisonings
. . . External Causes
Use E codes and/or Injury and Poisoning
 Look up injury in Index, circumstances in
E-Codes
Elderly patient fell, sprained internal
collateral ligament in ankle while stepping
from curb:
Sprains and strains of ankle and foot 845.01
Fall on or from sidewalk curb E880.1
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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 Ecode for the therapeutic use of the drug.
Patient develops hives after taking penicillin
Allergic urticaria 708.0
Penicillin poisoning 960.0
Therapeutic penicillin E930.0
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Using IT Coding Aids
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Online ICD-9 Search
at CDC Wonder
InfoRetriever on PDA,
desktop or online
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ICD-9 Coding module
5 Minute Clinical
Consult
Encoder Pro and
Code-it-Fast
First Consultonline
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Other PDA coding
software
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Bluefish RX ICD and
CPT
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