ICD-9-CM, ICD-10-CM, and ICD-10-PCS Coding Systems Chapter 2 ICD-9-CM, ICD-10-CM, and ICD-10-PCS Coding Systems

Disease Classifications ICD ICD-9-CM ICD-10-CM ICD-10-PCS

ICD-10-CM Coding Manual Permission to reuse granted by Ingenix, Inc.

ICD-9-CM Volume 1: Tabular List Volume 2: Index to Diseases Volume 3: Index to Procedures and Tabular List

Oversight of ICD-9-CM National Center for Health Statistics (NCHS) Centers for Medicare and Medicaid Services (CMS) Updates April 1 and October 1 of each year

Legislation Medicare Prescription Drug, Improvement, and Modernization Act (MMA) Medicare Catastrophic Coverage Act of 1988

History of ICD World Health Organization (WHO) originally intended for use as statistical tool 1955 ICD-7 clinically modified for indexing hospital disease in United States (continued)

History of ICD 1965 ICD-8 lacked depth of clinical data for United States health care delivery system 1968 Two widely accepted modifications published: ICDA-8 H-ICDA (continued)

History of ICD 1979 2013 ICD-9-CM implemented ICD-10-CM and ICD-10-PCS implemented

Coding Tools Non-automated Automated Coding manuals Reference materials Automated Computer-based encoders Web-based products (continued)

Coding Tools Updateable ICD-9-CM coding manuals. Permission to reuse granted by Ingenix, Inc.

Medical Necessity Determination that service or procedure provided is reasonable and necessary for diagnosis or treatment of illness or injury e.g., patient underwent blood glucose testing (procedure) for hyperglycemia (illness)

Tabular List of Diseases Arrangement Numerical order 17 chapters Two supplementary classifications Five appendices

Disease and Injury Codes Category codes Three digits e.g., 436 Subcategory codes Three digits followed by decimal point and one additional digit e.g., 401.9 (continued)

Disease and Injury Codes Sub-classification code Three digits followed by decimal point and two additional digits e.g., 402.90

Procedure Codes Category codes Subcategory codes Two digits e.g., no valid two-digit ICD-9-CM Volume 3 codes Subcategory codes Two digits followed by decimal point and one additional digit e.g., 10.6 (continued)

Procedure Codes Sub-classification code Two digits followed by decimal point and two additional digits e.g., 82.01

Supplementary Classifications ICD-9-CM V codes Health status factors ICD-9-CM E codes External causes of injury, poisoning, or adverse reaction (continued)

Supplementary Classifications ICD-9-CM E codes / ICD-10-CM S&T codes Environmental events, industrial accidents, criminal activity, etc.

ICD-9-CM Appendices Appendix A: Morphology of Neoplasms Appendix B: Glossary of Mental Disorders Removed from ICD-9-CM effective 2006 Appendix C: Classification of Drugs by American Hospital Formulary Service (AHFS) (continued)

ICD-9-CM Appendices Appendix D: Classification of Industrial Accidents According to Agency Appendix E: List of Three-Digit Categories

ICD-9-CM Appendix A Morphology of Neoplasms (M codes) M8000/3 Benign Malignant

ICD-9-CM Appendix B Glossary of Mental Disorders Removed from ICD-9-CM Located in Diagnostic and Statistical Manual of Mental Disorders (DSM)

ICD-9-CM Appendix C Classification of Drugs by AHFS Numerical arrangement e.g., 76:00 Oxytocics

ICD-9-CM Appendix D Classification of Industrial Accidents According to Agency Tenth International Conference of Labor Statisticians Used to classify industrial accidents

ICD-9-CM Appendix E List of Three-Digit Categories e.g., 390-392 Acute rheumatic fever

ICD-9-CM Index to Diseases and ICD-10-CM Index to Diseases and Injuries Index of Diseases Table of Drugs and Chemicals Alphabetic Index to External Causes of Injury and Poisoning

Index to Diseases Arrangement Alphabetic Main terms e.g., conditions Nonessential modifiers in parentheses (continued)

Index to Diseases Arrangement Essential modifiers indented Sub-terms Qualifiers further indented Second and third

Basic Steps to Coding Diseases Locate main term in Index to Diseases Follow directional terms e.g., see, see also, see category Review diagnostic statement to locate essential modifiers in Index to Diseases e.g., sub-terms Select and verify code in Tabular List of Diseases (continued)

Tabular List of Procedures and Index to Procedures Volume 3 of ICD-9-CM ICD-10-PCS Alphabetic listing of main terms e.g., procedures Nouns, adjectives, or eponyms Use of “with” and “without” Sub-terms

Basic Steps to Coding Procedures Locate main term in Index to Procedures Follow directional terms e.g., omit code Review procedural statement to locate essential modifiers in Index to Procedures e.g., sub-terms Select and verify code in Tabular List of Procedures

Guidelines for Coding and Reporting Using ICD-9-CM and ICD-10-CM/PCS Cooperating parties CMS NCHS Impact of HIPAA Coding guidelines Use of terms “encounter” and “provider” Guidelines for ICD-10-CM/PCS