1. Copyright, 1996 © Dale Carnegie & Associates, Inc.

2. Getting to know the ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification Intention is to describe the clinical picture of the patient more precisely Used in medical records, medical and ambulatory care, and review

3. Updates to the ICD-9 New books published yearly ICD-10-M is used to code and classify mortality data from death certificates

4. Why Use ICD Codes? Data storage and retrieval Maximize reimbursement by accurate coding Shorten claims processing time Facilitate measurement of compliance with clinical guidelines

5. Format and Conventions of ICD-9-CM Volume 1, Tabular List Classifies diseases and injuries according to etiology and organ systems, dividing them into groups: Anatomical system type of condition Related groups of codes Three-digit codes (category codes) Fourth-digit codes (subcategory codes) Fifth-digit codes (subclassification codes)

6. Format and Conventions of ICD-9-CM Cont. Classifications of Sections and Structures of Chapters 1 thru 17 Subdivided as follows: Section: group of three-digit code numbers describing a general disease category Category: three-digit code representing a specific disease within the section Subcategory: further breakdown of the category, assigning a fourth digit Subclassification: five-digit code giving the highest level of specificity to the disease state

7. Example of Chapter Structure Chapter: Diseases of the Circulatory System Chapter Seven (390-459) Section: Hypertensive Disease (401-405) Category: Hypertensive Heart Disease (402) Subcategory: Malignant (402.0) Subclassification: Without heart failure (402.00) Malignant hypertensive heart disease without heart failure = 402.00

8. Format and Conventions of ICD-9-CM Cont. Volume 2, Alphabetic Index Alphabetic Index of disease and injury Divided into three sections: index of diseases poison and external causes of adverse affects of drugs and other chemical structures Alphabetic index of external causes of injury and poisoning

9. Format and Conventions of ICD-9-CM Cont. Volume 3, Procedures: Tabular List and Alphabetic Index Primarily used in hospital facilities to code procedures

10. Symbols, Abbreviations, Punctuations and Notations Instructions for use READ CAREFULLY NEC - not elsewhere classifiable and NOS - not otherwise specified - only use these codes when you don’t have more information to be more specific

11. Steps in ICD Coding Identify the key terms in the diagnostic statement check documentation for preexisting conditions to ensure they are still being treated Never code conditions described as “rule out”, “suspected”, “probable”, or “questionable” - code symptoms until diagnosis is confirmed Cannot use codes just because they will get the service covered by insurance

12. Steps in ICD Coding Cont. Locate the diagnosis in the Alphabetic Index (Volume 2) Read any footnotes, symbols or instructions Locate the code in the Tabular List Read inclusions and exclusions Include fourth and fifth digits when available Assign the code

13. Special Codes V Codes - used for preventive visits when patient is not currently ill (physical exams) Example: Exposure to rabies by rabid skunk, Code as V01.5 E Codes - used to classify environmental causes of injury, poisoning, or other adverse effect Example: Accident caused by explosive material, explosive gases, Butane Code, Code as E923.2

14. Special Codes Cont. Symptoms, Signs and Ill-defined Conditions, Chapter 16 - use when definite diagnosis is unknown Example: Rule out myocarial infarction, Code as “CC chest pain” 786.50

15. Appendices 5 appendices in Volume 1 Morphology of Neoplasms - all cancer codes by histology, location, and behavior Glossary of Mental Disorders - psychiatric terminology Classification of Drugs - adverse effect of drugs Classification of Industrial Accidents - injuries categorized by industrial agency List of Three-digit Categories - breakdown of chapter categories

16. Coding tips and hints Always have a good medical dictionary Use the most recent ICD manual Make notes in your books Don’t code only from the Alphabetic Index Diagnoses are listed by first word, by a key word in a phrase, or by anatomical site involved

17. Coding tips and hints Cont. Avoid nonspecific codes Be careful when coding preexisting conditions Documentation must support the diagnosis Inaccurate coding can lead to accusations of fraud and abuse