ICD-9-CM with ICD-10 Coding Guidelines Chapter 4 ICD-9-CM with ICD-10 Coding Guidelines

ICD-9-CM and ICD-10-CM Official Guidelines for Coding and Reporting Rules developed by cooperating parties for ICD-9-CM and ICD-10-CM to accompany and complement official conventions and instructions provided within ICD-9-CM and ICD-10-CM Companion to ICD-9-CM and ICD-10-CM (continued)

ICD-9-CM and ICD-10-CM Official Guidelines for Coding and Reporting Cooperating parties American Hospital Association (AHA) AHIMA CMS NCHS

HIPAA Alert! HIPAA regulations require providers and third-party payers to adhere to ICD-9-CM Official Guidelines for Coding and Reporting Violation of coding guidelines is violation of HIPAA Effective October 1, 2013, ICD-10-CM/PCS replaces ICD-9-CM

Official Guidelines for Coding and Reporting Four sections Section I Section II Section III Section IV

Historical Perspective Bertillon International Statistical Classification of Causes of Death ICD ICD-9-CM ICD-10-CM and ICD-10-PCS

General Guidelines Use both Index to Diseases and Tabular List of Diseases Locate term in Index to Diseases first and verify code in Tabular List of Diseases Assign highest level of digits available

Guidelines Signs and symptoms integral to disease should not be assigned as additional codes Etiology and manifestation convention requires two codes to be reported to completely describe a single condition (continued)

Guidelines Multiple coding Acute (or subacute) and chronic conditions Use additional code Code first If applicable, code any causal condition first Acute (or subacute) and chronic conditions 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 Combination code assigned e.g., painful cicatrix following severe burn to elbow, left-sided paralysis due to previous cerebrovascular accident (CVA)

Chapter-Specific Diagnosis Coding Guidelines Principal diagnosis Secondary diagnoses First-listed diagnosis

Chapter 1: Infectious and Parasitic Diseases ICD-9-CM: 001-139 ICD-10-CM: A00-B99 Organisms Infections (continued)

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 Acquired immune deficiency syndrome (AIDS)

HIV HIV-related conditions and opportunistic infections Sequence HIV code (ICD-9-CM: 042, ICD-10-CM: B20) first and then opportunistic infection code Sequencing of HIV codes with admission for unrelated condition (continued)

HIV Asymptomatic HIV Inconclusive HIV serology

Chapter 2: Neoplasms ICD-9-CM: 140-239 ICD-10-CM: C00-D499 Neoplasm “New growths or tumors in which cell reproduction is out of control” Benign Malignant (continued)

Chapter 2: Neoplasms Six classifications: Primary malignancy Secondary malignancy Carcinoma (CA) in situ Benign Uncertain behavior Unspecified nature (continued)

Chapter 2: Neoplasms Contiguous sites (overlapping sites) Re-excision of tumors

Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders ICD-9-CM: 240-279 ICD-10-CM: D50-D89 Diabetes mellitus Type 1 Patient’s body unable to produce insulin Type 2 Patient’s body unable to properly use insulin produced

Chapter 4: Diseases of the Blood and Blood-Forming Organs ICD-9-CM: 280-289 ICD-10-CM: D50-D89 Hematopoiesis Anemia Red cell volume Hemoglobin content (continued)

Chapter 4: Diseases of the Blood and Blood-Forming Organs Shape (morphology) Purpura

Chapter 5: Mental Disorders ICD-9-CM: 290-319 ICD-10-CM: F01-F99 WHO guidelines When classifying behavioral disorders, organically based illnesses reported before functional illnesses Within functional group, classify disorders as psychoses, neuroses, personality disorders, and others (continued)

Chapter 5: Mental Disorders WHO guidelines When coding mental illnesses associated with physical conditions, assign as many codes as necessary to fully describe clinical picture New for ICD-10-CM Pain disorders in psychological factors

Chapter 6: Nervous System and Sense Organs ICD-9-CM: 320-389 ICD-10-CM: G00-G99, H00-H95 Nervous system, including meninges Central nervous system Brain Spinal cord Peripheral nervous system

Chapter 7: Circulatory System ICD-9-CM: 390-459 ICD-10-CM: I00-I99 Hypertension, hypertensive table Malignant (accelerated) Benign Unspecified (continued)

Chapter 7: Circulatory System Cerebral infarction, stroke, CVA Late effects of cerebrovascular disease Myocardial infarction

Chapter 8: Respiratory System ICD-9-CM: 460-519 ICD-10-CM: J00-J99 Nose, sinuses, pharynx, larynx, trachea, bronchi, and lungs Chronic obstructive pulmonary disease Refer to main term “obstruction” (continued)

Chapter 8: Respiratory System Pneumonia Asthma (status asthmaticus) Acute exacerbation

Chapter 9: Digestive System ICD-9-CM: 520-579 ICD-10-CM: K00-K94 Major digestive organs include pharynx, esophagus, stomach, and intestines Accessory (secondary) organs include salivary and parotid glands, jaw, and teeth (continued)

Chapter 9: Digestive System Structures that support digestive process are gallbladder, pancreas, and liver

Chapter 10: Genitourinary System ICD-9-CM: 580-629 ICD-10-CM: N00-N99 Chronic kidney disease (CKD) Kidney transplant status ICD-9-CM: V42.0 ICD-10-CM: Z94.0 CKD with other conditions

Chapter 11: Pregnancy, Childbirth, and Puerperium ICD-9-CM: 630-677 ICD-10-CM: O00-O9A Conditions occurring during pregnancy, childbirth, and six weeks immediately following childbirth Never report these codes on baby’s record (continued)

Chapter 11: Pregnancy, Childbirth, and Puerperium Outcome of delivery ICD-9-CM: V27.0-V27.9 ICD-10-CM: Z37.1-Z37.9 (continued)

Chapter 11: Pregnancy, Childbirth, and Puerperium ICD-9-CM: 630-633 (ectopic or molar pregnancy) ICD-10-CM: O00-O02 (continued)

Chapter 11: Pregnancy, Childbirth, and Puerperium ICD-9-CM: 639 (complications following abortion and ectopic or molar pregnancy) ICD-10-CM: O08 Fifth digits to identify abortive stage Unspecified (0) Incomplete (1) Complete (2) (continued)

Chapter 11: Pregnancy, Childbirth, and Puerperium ICD-9-CM: 640-648 (complications related to pregnancy) (continued)

Chapter 11: Pregnancy, Childbirth, and Puerperium ICD-9-CM: 650 (normal delivery) ICD-10-CM: O80 Minimal or no assistance Episiotomy permitted Fetal manipulation not permitted e.g., use of forceps (continued)

Chapter 11: Pregnancy, Childbirth, and Puerperium Except for ICD-10-CM, 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 ICD-9-CM: 680-709 ICD-10-CM: L00-L99 Epidermis, dermis, subcutaneous tissue, nails, sebaceous glands, sweat glands, hair, and hair follicles

Chapter 13: Musculoskeletal System and Connective Tissue ICD-9-CM: 710-739 ICD-10-CM: M00-M99 Bones, muscles, cartilage, fascia, ligaments, synovia, tendons, and bursa (continued)

Chapter 13: Musculoskeletal System and Connective Tissue Localized osteoarthrosis Primary Unknown etiology Secondary Caused by external or internal injury

Chapter 14: Congenital Anomalies ICD-9-CM: 740-759 ICD-10-CM: Q00-Q99 Classifies all conditions according to principal or defining defect rather than cause Except for chromosome abnormalities (continued)

Chapter 14: Congenital Anomalies May be apparent at birth or hidden and identified sometime after birth Codes may used throughout patient’s life

Chapter 15: Conditions Originating in Perinatal Period ICD-9-CM: 760-779 ICD-10-CM: P00-P96 Perinatal period Interval of time before, during, and up to 28 days following birth Never report these codes for mother’s episode of care

Chapter 16: Symptoms, Signs, and Ill-Defined Conditions ICD-9-CM: 780-799 ICD-10-CM: R00-R99 Includes symptoms, signs, and abnormal results of laboratory or other investigative procedures (continued)

Chapter 16: Symptoms, Signs, and Ill-Defined Conditions Key terms Abnormal, abnormality Decrease, decreased Elevation Findings, abnormal, without diagnosis

Chapter 17: Injury and Poisoning ICD-9-CM: 800-999 ICD-10-CM: S00-T98 Injuries Fractures Burns Adverse effects, poisonings, and toxic effects

Fractures Open/compound fracture Closed/simple fracture Comminuted Depressed Fissured Greenstick Impacted (continued)

Fractures Closed/simple fracture Complicated Malunion (late effect) Linear Slipped epiphysis Spiral fracture Complicated Malunion (late effect)

Burns ICD-9-CM: 940-949 ICD-10-CM: T20-T32 Classified according to: Depth First degree (erythema) Second degree (blistering) Third degree (full thickness) (continued)

Burns Classified according to: Extent Percentage of body surface Agent (e.g., chemicals, fire, sun) E codes assigned

Adverse Effects Also known as adverse reactions Appearance of pathologic condition caused by ingestion or exposure to chemical substance properly administered or taken e.g., allergic rash due to penicillin Table of Drugs and Chemicals

Poisonings Occur as result of overdose Wrong substance administered/taken or intoxication that involves combining prescribed drugs with nonprescribed drugs or alcohol e.g., coma due to overdose of codeine (continued)

Poisonings ICD-9-CM: 960-979 ICD-10-CM: T36-T65 Manifestation of poisoning

Toxic Effects ICD-9-CM: 980-989 ICD-10-CM: T51-T65 When someone ingests or comes into contact with harmful substance

V Codes ICD-9-CM: V01-V85 ICD-10-CM: A00-Y99 Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (continued)

V Codes Classifies occasions when circumstances other than disease or injury recorded as diagnoses or problems (continued)

V Codes Categories: Contact/exposure Inoculations and vaccinations Status History (of) Screening Observation Aftercare (continued)

V Codes Categories: Routine and administrative examinations Follow-up Donor Counseling Obstetrics and related conditions Newborn, infant, and child Routine and administrative examinations Miscellaneous

E Codes ICD-9-CM: E800-E999 ICD-10-CM: V00-Y99 Supplemental Classification of External Causes of Injury and Poisoning Classifies environmental events, circumstances, and conditions as cause of injury, poisoning, or other adverse effect (continued)

E Codes Reported in addition to code from Chapters 1-17 to indicate nature of condition