CHAPTER 2
AN OVERVIEW
OF ICD-9-CM
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 1
An Overview of the ICD-9-CM
• Classification System
– Morbidity (illness)
– Mortality (death)
• ICD = International Classification of Diseases
• WHO’s ICD-9 used globally
– World Health Organization
• ICD-9-CM = 9th Revision; CM, Clinical Modification
– Continuity of data
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 2
Overview
(…Cont’d)
• 1977: US develops ICD-9-CM version
• More code subsets define medical care
• ICD-9-CM data comparable to global
data in ICD-9
• Updated October 1 of each year
• Must use new codes as of October 1
• Also updates April 1 with no grace
period
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 3
Medicare
• Medicare Catastrophic Act of 1988
– Required use of ICD-9-CM codes for
diagnosis
• Act later repealed, but codes still used
• Effective 2003, all claims must have
valid diagnosis
– Excludes ambulance suppliers
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 4
Uses of ICD-9-CM
• Facilities track facility use through
codes
• Fiscal entities track health care costs
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 5
Uses of ICD-9-CM
(…Cont’d)
• Research
– Health care quality
– Future needs
• Newer cancer center built if patient use
warrants
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 6
Uses of ICD-9-CM
• Use and results evident every day
– Newscaster reference to number of AIDS
cases
– Newspaper article about measles epidemic
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 7
ICD-9-CM
Principles/Practices
Four groups function together to
maintain ICD-9-CM
• Centers for Medicare and Medicaid
Services (CMS), formerly known as
Health Care Financing Administration
(HCFA)
(Cont’d...)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 8
ICD-9-CM
Principles/Practices
(...Cont’d)
• National Center for Health Statistics
(NCHS)
• American Health Information
Management Association (AHIMA)
• American Hospital Association (AHA)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 9
ICD-9-CM Documents
Medical Necessity
• Diagnoses establish medical necessity
• Services and diagnoses must correlate
• Correct diagnosis codes allow:
– Accurate reimbursement
– Fewer rejected claims
– Reduced risk of sanctions/fines from audit
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 10
CMS-1500 (08/05) in Blocks 21
and 24E (Outpatient)
Courtesy U.S. Department of Health and Human Services, Public Health Service,
Centers for Medicare and Medicaid Services.
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 11
UB04 in Blocks 66-74
(Inpatient)
Courtesy U.S. Department of Health and Human Services, Public Health Service, Centers
for Medicare and Medicaid Services.
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 12
Ethics
• Documentation must support diagnosis
• Example:
– Services provided
– Diagnosis justifies services
• If in doubt, check it out; don’t make
assumptions
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 13
Your Job
• Translate documentation into ICD-9-CM
codes
– Legionnaires’ disease = 482.84
• Assign code to highest level specificity
• Medical record must substantiate
diagnosis code assignment
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 14
Format of the ICD-9-CM
• Volume 1, Diseases, Tabular List
(diagnosis) (17 chapters)
• Volume 2, Diseases, Alphabetic Index
(diagnosis) (3 sections)
• Volume 3, Procedures, Tabular List and
Alphabetic Index (inpatient)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 15
Volume 1, Diseases, Tabular List
• Contains code numbers
• 001.0-999.9 Diagnosis codes describe
condition
• V and E codes = supplemental
information
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 16
Volume 1, Diseases,
Tabular List
(...Cont’d)
Divided into:
• Chapter
– Section
• Category
– Subcategory
» Subclassification
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 17
Volume 2, Diseases, Alphabetic
Index
• Appears first in book (may vary with
publishers)
• Terms and code numbers verified in
Volume 1
• Never code directly from Index!
• Read all notes and follow instructions
(e.g., see also)
• Tables (e.g., Drugs/Chemicals,
Hypertension, Neoplasm)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 18
Volume 3, Procedures, Tabular
List and Alphabetic Index
• Not used for physician services
• Index and Tabular List used for
procedures and therapies
• Inpatient settings only
• Procedures and therapies
• Maximum 4 digits
– 20.41 Simple mastoidectomy
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 19
Volume 1, Tabular List
• Two major divisions
– Classification of Diseases and Injuries
(codes 001.0-999.9)
– Supplementary Classification
(V codes and E codes)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 20
V Codes (V01.0-______)
V89.09
• Patient not ill but encounters
health services
– e.g., Vaccination
• Patient presents for treatment
– e.g., Chemotherapy
• Some V codes are primary only (e.g.,
V58.11, encounter for chemotherapy)
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 21
V Codes (V01.0-V89.09)
(…Cont’d)
• Factors that influence patient’s health
status
– e.g., Personal history of [PHO] malignant
tumor, organ transplant
– Birth status and outcome of delivery
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 22
Classification of Diseases
and Injuries
• Main portion of ICD-9-CM
• Codes from 001.0-999.9
• Most chapters are organ systems
– Digestive System
– Respiratory System
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 23
Divisions of Classification
of Diseases and Injuries
• Chapters: 1 through 17
• Section: A group of related conditions
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 24
Volume 1, Diseases, Format
Figure: 2.5
Modified from Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St.
Louis, 2011, Saunders.
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 25
Category Code
Figure: 2.6
Modified from Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St.
Louis, 2011, Saunders.
• Category: Represent single
disease/condition (3 digits)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 26
Subcategory Code
Figure: 2.7
Modified from Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St.
Louis, 2011, Saunders.
• Subcategory: More specific (4th digit)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 27
Subclassification Code
Referenced from Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St.
Louis, 2011, Saunders.
• Subclassification: More specific (5th
digit)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 28
Specificity in ICD-9-CM Codes
Figure: 2.9
• Each digit adds to the specificity (detail)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 29
Remember
• Assign to the highest level possible,
based on documentation
• If 4-digit code exists, do not report
3-digit code
• If 5-digit code exists, do not report
4-digit code
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 30
Appendices in Volume 1
• There are five appendices in official
ICD-9-CM
• Private publishers may have more
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 31
Appendix A, Morphology
of Neoplasms
• Used in conjunction with codes from
Chapter 2, Neoplasm
– Inpatient setting: Cancer registries and
claim forms
– Not placed on a billing claim form
(M codes)
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 32
Appendix A, Morphology
of Neoplasms
(…Cont’d)
• Begins with M followed by 5 digits
– M8400/0, Sweat gland adenoma
• First four digits: Histologic type of
neoplasm
• Fifth digit: Behavior (e.g., 0 = benign)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 33
Appendix B, Glossary
of Mental Disorders
• Deleted in 2004
• Most psychiatric disorders are
classified using:
– The Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV)
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Slide 34
Appendix C, Drugs
• American Hospital Formulary Service
(AHFS) publishes list of all drugs
• Tracks drugs nationally; used by
pharmacists
• Each drug coded with up to six-digit
code (e.g., 84:04.04)
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 35
Appendix C, Drugs
(…Cont’d)
• AHFS listing correlated to ICD-9-CM
Table of Drugs and Chemicals
• New drugs not identified by name
– Rather listed under heading “Drug” in
Table of Drugs and Chemicals
– Example: 84:04.04 antibiotics
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 36
Appendix D, Industrial Accidents
• Three-digit codes that identify
occupational hazards
• Not placed on insurance or billing form
• Used by state and federal organizations
(OSHA) Occupational Safety and Health
Administration to summarize industrial
accident data
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 37
Appendix E, Three-Digit
Categories
• Presented by chapter
• Categories are labeled 1 through 17
• Provides quick overview of ICD-9-CM
contents
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 38
Volume 2, Sections
• Section 1, Index to Diseases
• Section 2, Table of Drugs and Chemicals
• Section 3, Index to External Causes of
Injuries and Poisonings (E Codes)
– Never primary diagnosis
– Medicare does not accept for professional
billing
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 39
Section 1, Index to Diseases
• Largest part of Volume 2—Index
• First step in coding, locate main bold term in
the Index
• Subterms indented 2 spaces to the right
• May have more than one subterm
• 3 digits = category codes
• 4 digits = subcategory
• 5 digits = subclassification codes
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 40
A Word of Caution About the
Alphabetic Index (Section I, Vol. 2)
• Some words in Index do not appear in
Tabular—saves space
• Exact word may not be in code Tabular
description
– But found in Alphabetic Index
– That is why you must locate term in Index
and then locate Tabular (follow where
Index directs)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 41
Section 2, Table of Drugs
and Chemicals
Modified from Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St.
Louis, 2011, Saunders.
• Drug name placed alphabetically on left
under heading “Substance”
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 42
Table of Drugs and Chemicals
(…Cont’d)
Modified from Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St.
Louis, 2011, Saunders.
• First column: “Poisoning” code for substance
involved, wrong substance given or taken
• First-listed before manifestation condition
(Cont’d…)
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Slide 43
Table of Drugs and Chemicals
(…Cont’d)
• E codes identify how poisoning occurred
– Example: If analgesics poisoning occurred by
accident, E850.9
• Correct order poisoning
– 3 codes required:
• Identify agent analgesic 965.9
• Condition—coma 780.01
• Accidental poison E850.9
• Correct order adverse effect
– 2 codes required
• Condition—coma 780.01
• Therapeutic E935.9
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Slide 44
Table of Drugs and
Chemicals: Headings
• Accident: Unintentional
• Therapeutic: Correct dosage, correctly
administered, with adverse effects
(example, allergic reaction)
• Suicide attempt: (must be documented)
• Assault: Intentionally inflicted by
another person
• Undetermined: Unknown intent
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Slide 45
E Codes (E000-E999)
• Supplementary Classification of
External Causes of Injury and
Poisoning
• Alpha-numerical designations for
injuries and poisonings
(Cont’d…)
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Slide 46
E Codes (E000-E999)
(…Cont’d)
• Provides additional information about
external causes
• Never a principal (inpatient) diagnosis
• Separate E code index
– Locate the E Code index in your ICD-9-CM
now
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 47
Section 3, E Codes
• Alphabetic Index to External Causes of
Injuries and Poisonings
• Provide additional information about
the nature of injury/poisoning and
locality
• Never a principal (inpatient) or firstlisted (outpatient) diagnosis
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Slide 48
Section 3, E Codes
(…Cont’d)
• Separate Index to External Causes
• Alphabetical, main terms in bold
• Subterms are indented 2 to right under main
term
• Some words in Index not in Tabular—saves
space
• That is why you must locate the term in the
Index, then locate in Tabular
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 49
Index to External Causes:
Example
• Main terms are type of accident (Collision)
• Subterms are circumstances of the
accident (motor vehicle)
Modified from Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition,
St. Louis, 2011, Saunders.
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 50
Volume 2, Neoplasm
• In Volume 2,
Index, locate
Neoplasm Table
under the
alphabetic entry
“N”
• Do not reference
Neoplasm table
when diagnostic
statement states
“mass”
From Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3,
Professional Edition, St. Louis, 2011, Saunders.
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 51
Volume 2, Terms
• Main terms (bold typeface)
– Subterms
– Indented two spaces to right
– Not bold
• Example
Pain (Main term in bold)
orbital region 379.91 (subterm indented)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 52
Volume 2, Alphabetic Index
• Nonessential modifiers enclosed in
parentheses (does not have to be in
diagnostic statement)
• Have no effect on code selection
• Clarify diagnosis
– Example: Ileus (adynamic) (bowel)….
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 53
ICD-9-CM Conventions
• Punctuation: [ ] ( ) : } italicized and bold
type [ ]
• Symbols: § 
• Abbreviations: NEC, NOS
• Notations: Includes, Excludes, Use
Additional Code, And/With, Code if
Applicable
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 54
Abbreviations
• NEC: Not elsewhere classifiable
– No more specific code exists
• NOS: Not otherwise specified
– Unspecified in documentation
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 55
[ ] Brackets
• Enclose synonyms, alternative
wording, or explanatory phrases
• Used to identify manifestation codes
• Helpful, additional information
• Can affect code
• Found only in Tabular List (001.0-999.9)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 56
Volume 2, Etiology and
Manifestation of Disease
• Etiology = cause of disease
• Manifestation = symptom
• Etiology + Manifestation =
Combination codes
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 57
Combination Code
Modified from Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional
Edition, St. Louis, 2011, Saunders.
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 58
Slanted Brackets [ ]
• Enclose manifestations of underlying
condition
– “Code first underlying disease”
• Used in the Alphabetic Index-Volume 2
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 59
Multiple Coding
Modified from Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional
Edition, St. Louis, 2011, Saunders.
• No combination code, use individual code(s)
in this order
– 250.4x
– 581.81
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 60
( ) Parentheses
• Contain non-essential modifiers
– Take them or leave them
– Informational descriptive terms
• Found in Tabular List and Index
• Does not affect code selection
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 61
Colon and Brace
• : Colon: In Tabular List, completes a
statement with one or more modifiers
• } Brace: In Tabular List, modifies
statements to the right of the brace
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 62
Italicized and Bold Type
• Italicized
– All Excludes notes
– Codes not used as principal diagnosis
• Bold
– Codes and code titles in Tabular List,
Volume 1
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 63
Lozenge and Section Mark
•  Lozenge: Indicates codes unique to
ICD-9-CM
• § Section: Can be footnote indicator
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 64
Includes, Excludes, and
Use Additional Code
• Includes notes: In chapter, section, or
category
• Excludes notes: Conditions are coded
elsewhere
• Use Additional Code: Assignment of
other code(s) is necessary
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 65
And/With
• And: Means and/or
– Example: 237.0, Neoplasm of uncertain
behavior of pituitary gland and/or
craniopharyngeal duct
• With: Means one condition with
(in addition to) another condition
– Example: 070.41, acute hepatitis C with
hepatic coma
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 66
Volume 2, Cross
References
• Directs you: see, see also, see category
• “see” directs you to specific term
– Example: Panotitis—“see” Otitis media
• “see also” directs you to another term
for more information
– Example: Perivaginitis (see also Vaginitis)
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 67
Volume 2, Cross
References
(…Cont’d)
• “see category” Volume 1, Tabular List,
specific information about use of code
– Example: Mesencephalitis (see also
Encephalitis) 323.9; late effect—see
category 326
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 68
Code, If Applicable, Any
Causal Condition First
• May be primary diagnosis if no causal
condition applicable or known or
documented
• Instructional note in Tabular List
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 69
Code, If Applicable, Any
Causal Condition First
(…Cont’d)
• Example: 707.10, Ulcer of lower limb,
except decubitus; states:
– Chronic venous hypertension with ulcer
(459.31)
• If ulcer caused by chronic venous
hypertension:
– First: 459.31 chronic venous hypertension
– Second: 707.10 ulcer of lower limb
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 70
Volume 2, Notes
• Define terms
• Give further coding instructions
– Example: Index: “Melanoma,”
• Note: “Except where otherwise indicated….”
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 71
Volume 2, Notes
(…Cont’d)
Figure: 2.13
From Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3,
Professional Edition, St. Louis, 2011, Saunders.
• Mandatory fifth digits also appear as notes (one
reason to never code from Index)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 72
Volume 2, Eponyms
• Disease or syndrome named for person
– Example:
• Arnold-Chiari (see also Spina bifida)
• Sturge-Weber
• Prader-Willi
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 73
Volume 3, Procedures
Figure: 2.14
Volume 3, Surgical procedures. (Modified from Buck CJ: 2011 ICD-9-CM
for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2011,
Saunders.)
• 90% of codes refer to surgical procedures
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 74
Volume 3, Procedures
(…Cont’d)
Figure: 2.15
Modified from Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis,
2011, Saunders.
• 10% refer to diagnostic and therapeutic
procedures
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 75
Volume 3, Procedures
(…Cont’d)
• Procedures done in physician’s office
or outpatient ASC are coded using CPT
codes
– Surgeon uses CPT to report services to
inpatients
• Volume 3, Procedure codes are used by
hospitals to code facility services
provided to inpatients
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 76
Volume 3, Table of Contents
• Chapter 0
– Procedures and Interventions, Not Elsewhere
Classified
• Chapters 1-15
– Operations on organ systems
• Chapter 16
– Miscellaneous Diagnostic and Therapeutic
Procedures
– Most nonsurgical codes
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 77
Volume 3, Table of Contents
(…Cont’d)
Figure: 2.16
Modified from Buck CJ:
2011 ICD-9-CM for
Hospitals, Volumes 1,
2, & 3, Professional
Edition, St. Louis,
2011, Saunders.
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 78
Volume 3, Tabular List
• Conventions in Volume 3 same as
those in Volumes 1 and 2
• “Code also...” Volume 3
– Additional information about coding
various components or special adjunctive
services or procedures
– “…any synchronous” means occurring at
the same time
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 79
Volume 3, Alphabetic Index
• Contains terms that do not appear in
Volume 3 Tabular List
– Example: In Index, the entry Gastrostomy,
subterm Janeway, directs you to 43.19
– Janeway not mentioned in Tabular List
(Cont’d…)
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Slide 80
Volume 3, Alphabetic Index
(…Cont’d)
• Terms in bold
• Subterms not in bold
• Never code directly from Index
• Index example follows
• Includes non-essential modifiers, as in
Volume 1
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Slide 81
Example
Figure: 2.17
Modified from Buck CJ: 2011 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St.
Louis, 2011, Saunders.
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 82
Volume 3, Alphabetic Index
• Index alphabetical
• Ignores single spaces and hyphens
– Example: Opening and open reduction
– “Opening” appears before “open
reduction” because space between two
words ignored
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 83
Volume 3, Alphabetic Index
(…Cont’d)
• Often necessary and permissible to code
individual components of procedure
– Example: During a procedure, a portion of
intestine was removed and reconstruction
of urinary bladder was done
• Both reconstruction (57.87) and
resection (45.51) are coded
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 84
Volume 3, Alphabetic Index
(…Cont’d)
• Cross references of see, see also, and
see category appear as they did in
Volume 1
• Many operations named for surgeon
who developed procedure (eponyms)
– These procedures located under person’s
name or name of operation
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 85
Volume 3, Tabular List
• Format same as Volume 1, Tabular List
of Diseases, except Volume 3 codes
have two digits before decimal
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 86
Volume 3, Tabular List
(…Cont’d)
• Category,
subcategory, and
subclassification
Figure: 2.18
Modified from Buck CJ:
2011 ICD-9-CM for
Hospitals, Volumes 1, 2, &
3, Professional Edition, St.
Louis, 2011, Saunders.
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 87
Bundling
• Included in all surgical procedures
opening and closing of surgical site
– Do not unbundle and code these
separately
– If closure takes place during separate
surgical procedure, closure can be
reported separately
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 88
Conclusion
CHAPTER 2
AN OVERVIEW
OF ICD-9-CM
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 89