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:
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
Locate term in the Index to Diseases
first, and verify the code in the Tabular
List of Diseases.
Assign the highest level of digits
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
Multiple coding
- Use additional code
- Code first
- If applicable, code any causal
condition first
Acute (or subacute) and chronic
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
“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
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
Chapter 4: Diseases of the Blood and
Blood-Forming Organs
Red cell volume
Hemoglobin content
Shape (morphology)
Chapter 5: Mental Disorders
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
Nervous system, including meninges
Central nervous system
- Brain
- Spinal cord
Peripheral nervous system
Chapter 7: Circulatory System
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
 Chronic obstructive pulmonary disease
- Refer to main term “obstruction”
 Pneumonia
 Asthma (status asthmaticus)
 Acute exacerbation
Chapter 9: Digestive System
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
Chronic kidney disease (CKD)
Kidney transplant status (V42.0)
CKD with other conditions
Chapter 11: Pregnancy, Childbirth,
and Puerperium
Conditions occurring during
pregnancy, childbirth, and six weeks
immediately following childbirth
Never report these codes on baby’s
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
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
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
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
Includes symptoms, signs and
abnormal results of laboratory or other
investigative procedures
Chapter 16: Symptoms, Signs, Ill-Defined
Key terms:
- Abnormal, abnormality
- Decrease, decreased
- Elevation
- Findings, abnormal, without diagnosis
Chapter 17: Injury and
Adverse effects, poisonings, and toxic
Open/Compound fracture
Closed/Simple fracture
- Comminuted
- Depressed
- Fissured
- Greenstick
- Impacted
Closed/Simple fracture
- Linear
- Slipped epiphysis
- Spiral fracture
Malunion (late effect)
 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
 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
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
V Codes
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
Supplemental Classification of External
Causes of Injury and Poisoning
Classifies environmental events,
circumstances, and conditions as cause
of injury, poisoning, or other adverse
E Codes
Reported in addition to a code from
Chapters 1-17 to indicate nature of
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