Chapter Ten

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CHAPTER 10
USING ICD-9-CM
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 1
Using ICD-9-CM
General Guidelines
Chapter 1,
Infectious and Parasitic
Diseases
Chapter 2,
Neoplasms
Chapter 3,
Endocrine, Nutritional and
Metabolic Diseases, and
Immunity Disorders
Chapter 4,
Diseases of Blood and BloodForming Organs
Chapter 5,
Mental, Behavioral and
Neurodevelopmental Disorders
Chapter 6,
Diseases of Nervous System
and Sense Organs
Chapter 7,
Diseases of Circulatory System
Chapter 8,
Diseases of Respiratory System
Chapter 9,
Diseases of Digestive System
Chapter 10, Diseases of Genitourinary
System
Chapter 11,
Complications of
Pregnancy, Childbirth,
and the Puerperium
Chapter 12,
Diseases of Skin and
Subcutaneous Tissue
Chapter 13,
Diseases of
Musculoskeletal
System and Connective
Tissue
Chapters
14 and 15,
Congenital Anomalies;
Certain Conditions
Originating in Perinatal
Period
Chapter 16,
Symptoms, Signs, and
Ill-Defined Conditions
Chapter 17,
Injury and Poisoning and
E Codes
Basic Coding Guidelines
ICD-10-CM
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 2
Using ICD-9-CM
• Guidelines developed by cooperating parties
• AHA (American Hospital Association)
• AHIMA (American Health Information
Management Association)
• CMS (Centers for Medicare and Medicaid
Services)
• NCHS (National Center for Health Statistics)
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 3
General Guidelines
• Appendix A of text contains link to access
Official Guidelines for Coding and
Reporting
• Inpatient coders use Sections I-III of
Guidelines
• Outpatient coders primarily use Sections I.
and IV., however…
(Cont’d…)
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 4
General Guidelines
(…Cont’d)
• Basic coding guidelines do NOT cover all
situations
– Outpatient coders also use many inpatient
guidelines
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 5
Steps to Accurate Coding
• Identify MAIN term(s) in diagnosis
• Locate MAIN term(s) in Index
• Review subterms
• Follow cross-reference instructions
– (e.g., see, see also)
• Verify code(s) in Tabular
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 6
Remember
• Read Tabular notes
• Code to highest specificity (detail)
• NEVER CODE FROM INDEX!
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 7
Guideline Section I.B.3.
Level of Detail in Coding
• Assign diagnosis to highest level of
specificity
– Do NOT use three-digit code if there is fourth
– Do NOT use four-digit code if there is fifth
• If not specific, claims bounce!
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 8
Guideline Section I.B.7. Conditions
integral to disease
• Signs and symptoms that are associated
routinely with a disease process should not
be reported separately, unless otherwise
instructed in the classification
• Example:
– Fever and shortness of breath due to
pneumonia
– Report only Pneumonia 486
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 9
Guideline Section I.B.8. Conditions
NOT integral to disease
• Additional signs and symptoms not
routinely associated with disease process
should be reported
• Example:
– Dehydration due to pneumonia
– Report
• Pneumonia and
• Dehydration
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 10
Section I.B.9. Multiple coding for a
single condition
• Etiology (cause)
• Manifestation (symptom)
– Slanted brackets [ ]
– Example: Retinopathy, diabetic 250.5 [362.01]
• Code as shown
– 250.5X
– 362.01
(Cont’d…)
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 11
Section I.B.9. Multiple coding
for a single condition
(…Cont’d)
• Must check Tabular notes to assign
correct fifth digit for diabetes
• Tabular: 362.0, Diabetic retinopathy,
instructs to “Code first diabetes 250.5”
– 250.5X Cause is diabetes
– 362.01 Manifestation is retinopathy
• Report 250.5X, 362.01
– X = required additional digit
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 12
Section I.B.10.
Acute and Chronic Conditions
• Exists alone or together
• May be separate or combo codes
• Reporting both codes, code acute first
(Cont’d…)
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 13
Section I.B.10.
Acute and Chronic Conditions
(…Cont’d)
• Example, acute and chronic pancreatitis
• When two separate codes exist, code:
– Acute pancreatitis 577.0
– Chronic pancreatitis 577.1
• Place acute first and chronic second
– 577.0, 577.1
(Cont’d…)
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 14
Section I.B.10.
Acute and Chronic Conditions
(…Cont’d)
• Combination code: Both acute and chronic
condition
• Diarrhea (acute) (chronic) 787.91
• Acute and subacute bacterial endocarditis
421.0
• Otitis acute and subacute 382.9
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 15
Section I.B.11.
Combination Code
• Always use combination code if one exists
– Example, encephalomyelitis (manifestation)
due to rubella (etiology), 056.01
• Assign only when code fully identifies
condition
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 16
Section I.B.12. Late Effects
• Ex., 701.4 followed by code 906.6
• Late effect is a residual of (remaining from)
previous illness/injury
– e.g., Scar produced by previous burn
• Residual coded first (scar)
• Late effect cause (burn) coded second, 906.6
• No time limit
• Generally requires 2 codes
(Cont’d…)
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 17
Late Effects
(…Cont’d)
• Late effect codes not in separate chapter
– Rather throughout Tabular
• Reference the term “Late” in the Index
• There is no time limit on developing a residual
• There may be more than one residual
– Example: Patient had a stroke and has residual
paralysis on dominant side (hemiparesis, 438.21) and
aphasia, 438.11
• Late effect means the original injury has healed
and you are dealing with a “residual” condition
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 18
Section I.C.7.d. Late Effects
of Cerebrovascular Disease
• 438 indicates conditions classified to 430437 as causes of Late Effects
• Code V12.54
– Assigned for TIA and cerebral infarction
without residual deficits
– Do not report from category 438
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 19
Conclusion
CHAPTER 10
USING ICD-9-CM
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 20
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