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Chapter 6 ICD-9-CM Coding
ICD-9-CM Coding <ul><li>International Classification of Diseases (ICD) </li></ul><ul><ul><li>Used to code and classify mor...
ICD-10-CM/PCS <ul><li>Will replace ICD-9 CM on October 1, 2013 </li></ul><ul><ul><li>More codes </li></ul></ul><ul><ul><li...
ICD-9-CM  Tabular List of Diseases <ul><li>Must be used to identify diagnoses, symptoms, conditions, problems, complaints,...
Level of Detail in Coding <ul><li>Codes contain three, four, or five digits </li></ul><ul><li>Codes with three digits: </l...
Sequencing  ICD-9-CM Diagnosis <ul><li>First code for the diagnosis, condition, problem, or other reason for encounter sho...
Encounter for  Services <ul><li>Diagnostic Services </li></ul><ul><li>First, report the diagnosis, condition, problem, or ...
Supplementary Classifications: V Codes and E Codes <ul><li>V codes are assigned when a circumstance other than a disease o...
Appendices <ul><li>Appendices serve in coding neoplasms, adverse effects of chemicals and drugs, and external causes of di...
Index to Diseases <ul><li>Step 1 </li></ul><ul><ul><li>Locate main term in the Index to Diseases </li></ul></ul><ul><li>St...
Coding conventions  –  rules that apply to the assignment of ICD-9-CM codes <ul><ul><li>Codes in slanted brackets </li></u...
Using the Tabular List <ul><li>After reviewing main terms and subterms </li></ul><ul><ul><li>Locate the first possible cod...
Index to Procedures and Tabular List of Procedures <ul><li>Principal Procedures </li></ul><ul><ul><li>A procedure performe...
Hypertension/Hypertensive Table <ul><li>Malignant </li></ul><ul><ul><li>Severe form of hypertension with vascular damage a...
Neoplasm Table <ul><li>Neoplasms </li></ul><ul><li>Another term related with neoplasm is  lesion </li></ul><ul><li>Primary...
Table of Drugs and Chemicals <ul><li>Poisonings occur as a result of an overdose, wrong substance administered or taken, o...
Supplementary Classifications <ul><li>ICD-9-CM contains two supplementary classifications: </li></ul><ul><ul><li>V codes  ...
E Codes <ul><li>Used to describe the circumstances of an illness or injury </li></ul><ul><li>Many states require their use...
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Chapter 6

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Chapter 6

  1. 1. Chapter 6 ICD-9-CM Coding
  2. 2. ICD-9-CM Coding <ul><li>International Classification of Diseases (ICD) </li></ul><ul><ul><li>Used to code and classify mortality ( death ) data from death certificates </li></ul></ul><ul><li>International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) </li></ul><ul><ul><li>Used to code and classify morbidity ( disease ) data from inpatient and outpatient records </li></ul></ul>
  3. 3. ICD-10-CM/PCS <ul><li>Will replace ICD-9 CM on October 1, 2013 </li></ul><ul><ul><li>More codes </li></ul></ul><ul><ul><li>Enhances accurate payment of services </li></ul></ul><ul><ul><li>Incorporates much greater specificity and clinical information </li></ul></ul><ul><ul><li>See file </li></ul></ul>
  4. 4. ICD-9-CM Tabular List of Diseases <ul><li>Must be used to identify diagnoses, symptoms, conditions, problems, complaints, or any other reason for the encounter/visit </li></ul><ul><li>Codes that describe signs and symptoms are acceptable for reporting purposes when the physician has not documented an established or confirmed diagnosis </li></ul>
  5. 5. Level of Detail in Coding <ul><li>Codes contain three, four, or five digits </li></ul><ul><li>Codes with three digits: </li></ul><ul><ul><li>Included in ICD-9-CM as the heading of a category of disease codes </li></ul></ul><ul><ul><li>Maybe further subdivided into four or five digits </li></ul></ul><ul><ul><ul><li>Provide greater specificity </li></ul></ul></ul>
  6. 6. Sequencing ICD-9-CM Diagnosis <ul><li>First code for the diagnosis, condition, problem, or other reason for encounter shown in the medical record to be chiefly responsible for the services provided </li></ul><ul><li>Additional codes that describe coexisting conditions that were treated or medically managed during the encounter should also be reported </li></ul>
  7. 7. Encounter for Services <ul><li>Diagnostic Services </li></ul><ul><li>First, report the diagnosis, condition, problem, or reason for encounter that is documented in the patient record as being chiefly responsible for the outpatient services provided during the encounter. </li></ul><ul><li>Therapeutic Services </li></ul><ul><li>Sequence first the diagnosis, condition, problem, or other reason for the encounter shown in the medical record to be chiefly responsible for the outpatient services pro- vided. </li></ul><ul><li>Assign code(s) to other diagnoses (e.g., chronic conditions) that are treated or medically managed or would affect thepatient’s receipt of services . </li></ul>
  8. 8. Supplementary Classifications: V Codes and E Codes <ul><li>V codes are assigned when a circumstance other than a disease or injury is present. </li></ul><ul><li>V codes provide codes to deal with encounters for circumstances other than a disease or injury </li></ul><ul><li>Like V codes, E codes are located in the Tabular List: </li></ul><ul><ul><li>E codes describe external causes of injury, like poisoning, accidents, or other adverse reactions affecting a patient’s health. </li></ul></ul>
  9. 9. Appendices <ul><li>Appendices serve in coding neoplasms, adverse effects of chemicals and drugs, and external causes of disease and injury. </li></ul><ul><li>In addition, the disease category codes are listed as an appendix. </li></ul><ul><li>Classification of industrial accidents according to agency based on employment injury statistics </li></ul>
  10. 10. Index to Diseases <ul><li>Step 1 </li></ul><ul><ul><li>Locate main term in the Index to Diseases </li></ul></ul><ul><li>Step 2 </li></ul><ul><ul><li>If the phrase “ see condition ” is found after the main term look at the descriptive term </li></ul></ul><ul><li>Step 3 </li></ul><ul><ul><li>When the condition listed cannot be found locate main terms such as syndrome, disease, disorder </li></ul></ul>
  11. 11. Coding conventions – rules that apply to the assignment of ICD-9-CM codes <ul><ul><li>Codes in slanted brackets </li></ul></ul><ul><ul><li>Eponyms </li></ul></ul><ul><ul><li>Essential modifiers </li></ul></ul><ul><ul><li>NEC </li></ul></ul><ul><ul><li>Nonessential modifiers </li></ul></ul><ul><ul><li>Notes </li></ul></ul><ul><ul><li>See </li></ul></ul><ul><ul><li>See also </li></ul></ul><ul><ul><li>See also condition </li></ul></ul>
  12. 12. Using the Tabular List <ul><li>After reviewing main terms and subterms </li></ul><ul><ul><li>Locate the first possible code in the Index to Disease. </li></ul></ul><ul><li>In the Tabular List </li></ul><ul><ul><li>Locate code, review code descriptions, review any EXCLUDES notes to determine whether the condition being coded is excluded. </li></ul></ul><ul><li>Assign any required fifth digit </li></ul>
  13. 13. Index to Procedures and Tabular List of Procedures <ul><li>Principal Procedures </li></ul><ul><ul><li>A procedure performed for definitive treatment rather than diagnostic purpose </li></ul></ul><ul><ul><li>One performed to treat a complication </li></ul></ul><ul><ul><li>One that is most closely related to principal diagnosis </li></ul></ul><ul><li>Secondary Procedures </li></ul><ul><ul><li>Additional procedures performed during same encounter as the principal procedure </li></ul></ul>
  14. 14. Hypertension/Hypertensive Table <ul><li>Malignant </li></ul><ul><ul><li>Severe form of hypertension with vascular damage and a diastolic pressure reading of 130 mmHg or greater </li></ul></ul><ul><li>Benign </li></ul><ul><ul><li>Mild or controlled hypertension </li></ul></ul><ul><li>Unspecified </li></ul><ul><ul><li>No notation of benign or malignant status </li></ul></ul>
  15. 15. Neoplasm Table <ul><li>Neoplasms </li></ul><ul><li>Another term related with neoplasm is lesion </li></ul><ul><li>Primary Malignancy </li></ul><ul><li>Secondary Malignancy </li></ul><ul><li>Carcinoma (Ca) in situ </li></ul><ul><li>TIP : other terms to consider are mass, cyst, dysplasia, polyp, adenosis </li></ul>
  16. 16. Table of Drugs and Chemicals <ul><li>Poisonings occur as a result of an overdose, wrong substance administered or taken, or intoxication. </li></ul><ul><li>Six columns in the table: </li></ul><ul><ul><li>Poisoning </li></ul></ul><ul><ul><li>Accident </li></ul></ul><ul><ul><li>Therapeutic use </li></ul></ul><ul><ul><li>Suicide attempt </li></ul></ul><ul><ul><li>Assault </li></ul></ul><ul><ul><li>Undetermined </li></ul></ul>
  17. 17. Supplementary Classifications <ul><li>ICD-9-CM contains two supplementary classifications: </li></ul><ul><ul><li>V codes </li></ul></ul><ul><ul><ul><li>Factors influencing health status and contact with health services </li></ul></ul></ul><ul><ul><li>E codes </li></ul></ul><ul><ul><ul><li>External causes of injury and poisoning </li></ul></ul></ul>
  18. 18. E Codes <ul><li>Used to describe the circumstances of an illness or injury </li></ul><ul><li>Many states require their use; insurance companies do not </li></ul><ul><li>Can expedite claims payment </li></ul><ul><li>NEVER use as a first-listed diagnosis on a claim </li></ul>

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