Presented by Cheryl Crosswhite, CPC

  Partial Freeze of Revisions: October 1, 2011 – last major update of ICD-9-CM  Annual update to ICD-9 is provided online on the CDC website: ICD-9-CM Official Guidelines for Coding and Reporting

  HIPAA regulations require providers and third party payers to adhere to ICD-9-CM Official Guidelines for Coding and Reporting.  A violation of coding guidelines is a violation of HIPAA. HIPAA Alert!

  Four Sections: - Section I - Section II - Section III - Section IV Official Guidelines for Coding & Reporting

  Use both the ICD-9-CM Index to Diseases and the Tabular List of Diseases.  Locate term in the Index to Diseases first, and verify the code in the Tabular List of Diseases.  Assign the highest level of digits available. General Guidelines

  Signs and symptoms that are integral to the disease should not be assigned as additional codes.  The etiology and manifestation convention requires two codes to be reported to completely describe a single condition. Guidelines

  Multiple coding - Use additional code - Code first - If applicable, code any causal condition first  Acute (or subacute) and chronic conditions  Combination code versus multiple code Guidelines

  Residual condition that develops after acute phase of illness or injury has ended - No time limit on reporting  For example, traumatic arthritis (residual) following fracture of the left ankle three years ago (cause) (716.17, 905.4)  Combination code assigned, for example aphasia due to cerebrovascular accident 6 months ago (438.11) Late Effect

  Principal diagnosis  Principal procedure  Secondary diagnoses  Secondary procedures  First-listed diagnosis Chapter-Specific Guidelines

   Organisms  Infections  “Supplemental Classification of Factors Influencing Health Status and Contact with Health Services”  Human immunodeficiency virus (HIV) Chapter 1: Infectious and Parasitic Diseases

  Key terms: - HIV disease - HIV infection - HIV infected - HIV positive - Acquired immune deficiency syndrome (AIDS) HIV Positive Status

   Neoplasm - “New growths or tumors in which cell reproduction is out of control”  Benign  Malignant Chapter 2: Neoplasms

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

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

   Diabetes mellitus - Type I: Patient’s body unable to produce insulin - Type II: Patient’s body unable to properly use insulin produced Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders

   Hematopoiesis  Anemia  Red cell volume  Hemoglobin content  Shape (morphology)  Purpura Chapter 4: Diseases of the Blood and Blood-Forming Organs

   WHO guidelines: - When classifying behavioral disorders, organically based illnesses are reported before functional illnesses. - Within a functional group, classify disorders as psychoses, neuroses, personality disorders, and others. Chapter 5: Mental Disorders

  WHO Guidelines: - When coding mental illnesses associated with physical conditions, assign as many codes as necessary to fully describe the clinical picture. Chapter 5: Mental Disorders

   Nervous system, including meninges  Central nervous system - Brain - Spinal cord  Peripheral nervous system Chapter 6: Nervous System and Sense Organs

   Hypertension, hypertensive table - Malignant (accelerated) - Benign - Unspecified  Cerebral infarction, stroke, CVA  Late effects of cerebrovascular disease  Myocardial infarction Chapter 7: Circulatory System

   Nose, sinuses, pharynx, larynx, trachea, bronchi, and lungs  Chronic obstructive pulmonary disease - Refer to main term “obstruction”  Pneumonia  Asthma (status asthmaticus)  Acute exacerbation Chapter 8: Respiratory System

   Major digestive organs include pharynx, esophagus, stomach, and intestines  Accessory (secondary) organs include salivary and parotid glands, jaw, and teeth  Structures that support the digestive process are gallbladder, pancreas, and liver Chapter 9: Digestive System

   Chronic kidney disease (CKD)  Kidney transplant status (V42.0)  CKD with other conditions Chapter 10: Genitourinary System

   Conditions occurring during pregnancy, childbirth, and six weeks immediately following childbirth  Never report these codes on baby’s record  Outcome of delivery (V27.0-V27.9 Chapter 11: Pregnancy, Childbirth, and Puerperium

  (ectopic or molar pregnancy)  639 (complications following abortion and ectopic or molar pregnancy)  Fifth digits to identify abortive stage - Unspecified (0) - Incomplete (1) - Complete (2) Chapter 11: Pregnancy, Childbirth, and Puerperium

  (complications related to pregnancy)  650 (normal delivery) - Minimal or no assistance - Episiotomy permitted - Fetal manipulation (e.g., use of forceps) not permitted Chapter 11: Pregnancy, Childbirth, and Puerperium

  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 11: Pregnancy, Childbirth, and Puerperium

   Epidermis, dermis, subcutaneous tissue, nails, sebaceous glands, sweat glands, hair, and hair follicles Chapter 12: Skin and Subcutaneous Tissue

   Bones, muscles, cartilage, fascia, ligaments, synovia, tendons, and bursa  Localized osteoarthrosis - Primary, unknown etiology - Secondary, caused by external or internal injury Chapter 13: Musculoskeletal System and Connective Tissue

   Classifies all conditions according to a principal or defining defect rather than cause - Except for chromosome abnormalities  May be apparent at birth or hidden and identified sometime after birth  Codes may be used throughout patient’s life Chapter 14: Congenital Anomalies

   Perinatal period - Interval of time before, during, and up to 28 days following birth  NEVER report these codes for the mother’s episode of care Chapter 15: Conditions Originating in Perinatal Period

   Includes symptoms, signs and abnormal results of laboratory or other investigative procedures Chapter 16: Symptoms, Signs, Ill-Defined Conditions

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

   Injuries  Fractures  Burns  Adverse effects, poisonings, and toxic effects Chapter 17: Injury and Poisoning

  Open/Compound fracture  Closed/Simple fracture - Comminuted - Depressed - Fissured - Greenstick - Impacted Fractures

  Closed/Simple fracture - Linear - Slipped epiphysis - Spiral fracture  Complicated  Malunion (late effect) Fractures

   Classified according to: - Depth  First degree (erythema)  Second degree (blistering)  Third degree (full thickness) - Extent  Percentage of body surface - Agent (e.g., chemicals, fire, sun)  E Codes assigned Burns

  Adverse effect (adverse reaction) - Appearance of pathologic condition caused by ingestion or exposure to chemical substance properly administered or taken - For example, allergic rash due to penicillin - Table of Drugs and Chemicals Adverse Effects, Poisonings, and Toxic Effects

  Occurs as result of overdose  Wrong substance administered or taken or intoxication that involves combining prescribed drugs with non-prescribed drugs or alcohol  For example, coma due to overdose of codeine Poisoning

   Manifestation of poisoning  Accidental (E850-E869)  Suicide attempt (E950-E952)  Assault (E961-E962)  Undetermined (E980-E982) Poisoning

  When someone ingests or comes into contact with a harmful substance Toxic Effects

  V01-V85  Supplementary Classification of Factors Influencing Health Status and contact with Health Services  Classifies occasions when circumstances other than disease or injury are recorded as diagnoses or problems V Codes

  Categories: - Contact/Exposure - Inoculations and vaccinations - Status - History (of) - Screening - Observation - Aftercare V Codes

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

  E800-E999  Supplemental Classification of External Causes of Injury and Poisoning  Classifies environmental events, circumstances, and conditions as cause of injury, poisoning, or other adverse effect E Codes

  Reported in addition to a code from Chapters 1-17 to indicate nature of condition  Machinery accidents (E919)  Late effects of accidents (E929, E959, E969, E977, E989, E999)  Transport accidents (E800-E848) E Codes

  Place of occurrence (E849) - Describes place where event occurred, NOT patient’s activity at the time E Codes