Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 4 USING ICD-9-CM

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2 Using ICD-9-CM General Guidelines Chapter 1, Infectious and Parasitic Diseases Chapter 2, Neoplasms Chapter 3, Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders Chapter 4, Diseases of Blood and Blood- Forming Organs Chapter 5, Mental Disorders Chapter 6, Diseases of Nervous System and Sense Organs Chapter 7, Diseases of Circulatory System Chapter 8, Diseases of Respiratory System Chapter 9, Diseases of Digestive System Chapter 10,Diseases of Genitourinary System Chapter 11, Complications of Pregnancy, Childbirth, and the Puerperium Chapter 12, Diseases of Skin and Subcutaneous Tissue Chapter 13, Diseases of Musculoskeletal System and Connective Tissue ChaptersCongenital Anomalies; 14 and 15, Certain Conditions Originating in Perinatal Period Chapter 16, Symptoms, Signs, and Ill-Defined Conditions Chapter 17, Injury and Poisoning and E Codes Basic Coding Guidelines ICD-10-CM

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3 Using ICD-9-CM Guidelines developed by cooperating partiesGuidelines developed by cooperating parties AHA (American Hospital Association)AHA (American Hospital Association) AHIMA (American Health Information Management Association)AHIMA (American Health Information Management Association) CMS (Centers for Medicare andMedicaid Services)CMS (Centers for Medicare and Medicaid Services) NCHS (National Center for Health Statistics)NCHS (National Center for Health Statistics)

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4 General Guidelines Appendix A of text contains official GuidelinesAppendix A of text contains official Guidelines Inpatient coders use Sections I-III of GuidelinesInpatient coders use Sections I-III of Guidelines Outpatient coders primarily use Sections I and IV, however…Outpatient coders primarily use Sections I and IV, however… (Cont’d…)

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5 General Guidelines (…Cont’d) Basic coding guidelines do NOT cover all situationsBasic coding guidelines do NOT cover all situations –Outpatient coders also use many inpatient guidelines

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6 Steps to Accurate Coding Identify MAIN term(s) in diagnosisIdentify MAIN term(s) in diagnosis Locate MAIN term(s) in IndexLocate MAIN term(s) in Index Review subtermsReview subterms Follow cross-reference instructionsFollow cross-reference instructions –(e.g., see, see also) Verify code(s) in TabularVerify code(s) in Tabular

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7 Remember Read Tabular notesRead Tabular notes Code to highest specificity (detail)Code to highest specificity (detail) NEVER CODE FROM INDEX!NEVER CODE FROM INDEX!

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8 Guideline Section I.B.3. Level of Detail in Coding Assign diagnosis to highest level of specificityAssign diagnosis to highest level of specificity –Do NOT use three-digit code if there is fourth –Do NOT use four-digit code if there is fifth If not specific, claims bounce!If not specific, claims bounce!

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9 Guideline Section I.B.7. Conditions integral to disease Signs and symptoms that are associated routinely with a disease process should not be reported separately, unless otherwise instructed in the classificationSigns and symptoms that are associated routinely with a disease process should not be reported separately, unless otherwise instructed in the classification Example:Example: –Fever and shortness of breath due to pneumonia –Report only Pneumonia 486

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10 Guideline Section I.B.8. Conditions NOT integral to disease Additional signs and symptoms not routinely associated with disease process should be reportedAdditional signs and symptoms not routinely associated with disease process should be reported Example:Example: –Dehydration due to pneumonia –Report Pneumonia andPneumonia and dehydrationdehydration

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11 Section I.B.9. Multiple coding for a single condition Etiology (cause)Etiology (cause) Manifestation (symptom)Manifestation (symptom) –Slanted brackets [ ] –Example: Retinopathy, diabetic [362.01] Code as shownCode as shown –250.5X – (Cont’d…)

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12 Section I.B.9. Multiple coding for a single condition (…Cont’d) Must check Tabular notes to assign correct fifth digit for diabetesMust check Tabular notes to assign correct fifth digit for diabetes Tabular: 362.0, Diabetic retinopathy, instructs to “Code first diabetes 250.5”Tabular: 362.0, Diabetic retinopathy, instructs to “Code first diabetes 250.5” –250.5X Cause is diabetes – Manifestation is retinopathy Report 250.5X, Report 250.5X, –X = required additional digit

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13 Section I.B.10. Acute and Chronic Conditions Exists alone or togetherExists alone or together May be separate or combo codesMay be separate or combo codes Reporting both codes, code acute firstReporting both codes, code acute first (Cont’d…)

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14 Section I.B.10. Acute and Chronic Conditions (…Cont’d) Example, acute and chronic pancreatitisExample, acute and chronic pancreatitis When two separate codes exist, code:When two separate codes exist, code: –Acute pancreatitis –Chronic pancreatitis Place acute first and chronic secondPlace acute first and chronic second –577.0, (Cont’d…)

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 15 Section I.B.10. Acute and Chronic Conditions (…Cont’d) Combination code: Both acute and chronic conditionCombination code: Both acute and chronic condition Diarrhea (acute) (chronic) Diarrhea (acute) (chronic) Acute and subacute bacterial endocarditis 421.0Acute and subacute bacterial endocarditis Otitis acute and subacute 382.9Otitis acute and subacute 382.9

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 16 Section I.B.11. Combination Code Always use combination code if one existsAlways use combination code if one exists –Example, encephalomyelitis (manifestation) due to rubella (etiology), Assign only when code fully identifies conditionAssign only when code fully identifies condition

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 17 Section I.B.12. Late Effects Ex., followed by code 906.6Ex., followed by code Late effect is a residual of (remaining from) previous illness/injuryLate effect is a residual of (remaining from) previous illness/injury –e.g., Scar produced by previous burn Residual coded first (scar)Residual coded first (scar) Late effect cause (burn) coded second 906.6Late effect cause (burn) coded second No time limitNo time limit Generally requires 2 codesGenerally requires 2 codes (Cont’d…)

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 18 Late Effects (…Cont’d) Late effect codes not in separate chapterLate effect codes not in separate chapter –Rather throughout Tabular Reference the term “Late” in the IndexReference the term “Late” in the Index There is no time limit on developing a residualThere is no time limit on developing a residual There may be more than one residualThere may be more than one residual –Example: Patient had a stroke and has residual paralysis on dominant side (hemiparesis, ) and aphasia, Late effect means the original injury has healed and you are dealing with a “residual” conditionLate effect means the original injury has healed and you are dealing with a “residual” condition

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 19 Section I.C.7.d. Late Effects of Cerebrovascular Disease 438 indicates conditions classified to as causes of Late Effects438 indicates conditions classified to as causes of Late Effects Code V12.54Code V12.54 –Assigned for TIA and cerebral infarction without residual deficits –Do not report from category 438

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 20 Conclusion CHAPTER 4 USING ICD-9-CM