1. Slide 1 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. CHAPTER 9 ICD-9-CM OUTPATIENT CODING AND REPORTING GUIDELINES

2. Slide 2 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section IV. Diagnostic Coding Physician’s office Hospital-based outpatient services Part of Official Guidelines for Coding and Reporting, Section __ IV

3. Slide 3 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section IV. Diagnostic Coding Guidelines do not address specific sequencing or diseases as inpatient do Though not stated, if there is no outpatient guideline, follow inpatient guidelines

4. Slide 4 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Coding Guideline A Term first-listed diagnosis, rather than principal diagnosis Outpatient Surgery: Reason for surgery –Even if surgery is canceled due to contraindication

5. Slide 5 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Coding Guideline A Observation Stay: Medical condition that occasioned admission –Assign a code from medical condition Observation Stay: Complications from outpatient surgery lead to observation report: Reason for surgery as first reported diagnosis Codes for complications necessitating observation

6. Slide 6 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Selection of First-Listed Diagnosis Condition for encounter –Why patient presented, not necessarily most serious condition noted Documented Chiefly responsible for services provided Also list ________ conditions coexisting

7. Slide 7 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnosis and Services Diagnosis and procedure MUST _______ Medical ________ must be established through documentation No correlation = No ____________ correlate necessity reimbursement

8. Slide 8 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Symptoms, Signs, and Ill- Defined Conditions Can be the first-listed diagnosis if no more specific diagnosis available Diagnoses often are not established at the time of the initial encounter/visit

9. Slide 9 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Coding Guideline B Use codes 001.0 through V91.99 to code: –Diagnosis –Symptoms –Conditions –Problems –Complaints –Or other reason(s) for visit

10. Slide 10 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline C Documentation should describe patient's condition, using terminology that includes: –Specific diagnoses –Symptoms –Problems –Reasons for encounter

11. Slide 11 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline D Selection of codes 001.0 through 999.9 (Chapters 1-17) frequently used to describe reason for encounter

12. Slide 12 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline E Codes that describe symptoms and signs, as opposed to diagnoses, acceptable for reporting purposes when –An _________ diagnosis has NOT been determined by physician established

13. Slide 13 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline F V codes deal with encounters for circumstances other than disease or injury –Example: Well-baby checkup See Section I.C.18. for information on V codes

14. Slide 14 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.18. Classification of Factors Influencing Health Status and Contact with Health Service V01-V91 –Assigned as first-listed diagnosis for: Admissions for _________ Following an _______ that would ordinarily result in health problem, BUT there is none –Car accident, driver hits head, no apparent injury, admit to R/O head trauma –Never a secondary diagnosis evaluation accident

15. Slide 15 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. V Codes Located after _____ in Tabular Two digits before decimal (e.g., V10.1X) Index for V codes is Alphabetic Index to Diseases Main terms: –Contraception –Counseling –Dialysis –Status –Examination 999.9

16. Slide 16 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Uses of V Codes Not ____ BUT receives health care (e.g., vaccination) Services for known/resolving disease/injury (e.g., chemotherapy) Codes for “aftercare” (e.g., surgery or fracture) Indicate birth status/outcome of delivery sick (Cont’d…)

17. Slide 17 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Uses of V Codes (…Cont’d) A circumstance/problem that influences patient’s health BUT NOT ______ illness/injury –Example: Organ transplant status –Example: Birth status and outcome of delivery (newborn) Section _______ of Guidelines contains V code list –Identifies if V code can be listed as first, first/additional, additional only current I.C.18.e.

18. Slide 18 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. History V Code Categories in Tabular ___ Personal history of malignant neoplasm V11 Personal history of mental illness V12 ________ history of certain other diseases V13 Personal history of other diseases V14 Personal history of allergy to medicinal agents V15 Other personal history presenting hazards to health V16 ______ history of malignant neoplasm V17 Family history of certain chronic disabling diseases V18 Family history of certain other specific diseases V19 Family history of other conditions Condition no longer present or treated V10 Personal Family

19. Slide 19 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline G Codes have either 3, 4, or 5 digits 4 and/or 5 digit codes provide greater ________ (detail) specificity (Cont’d…)

20. Slide 20 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline G (…Cont’d) 3-digit code used ONLY if no 4 or 5 digit Where 4 and/or 5 digits provided, must be assigned Diagnoses NOT coded to full digits available invalid Claims bounce!

21. Slide 21 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline H List first code for diagnosis, condition, problem, or other reason for encounter/visit shown in medical record to be chiefly responsible for services provided List additional codes that describe any ________ conditions Assign V72.5 and V72.6X for routine lab/radiology test ordered without signs, symptoms, or associated diagnosis coexisting

22. Slide 22 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline I Do NOT code diagnoses documented as probable, ________, questionable, rule out, or working diagnoses Rather, code condition(s) to suspected ______ degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for visit suspected highest

23. Slide 23 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline J Chronic diseases treated on an ongoing basis may be coded and _______ as many times as patient receives ________ and care for condition(s) reported treatment

24. Slide 24 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline K Code all documented conditions that ______ at time of visit, that require or _____ patient care, treatment, or management Do NOT code conditions previously treated, no longer existing coexist affect (Cont’d…)

25. Slide 25 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline K (…Cont’d) “History of” codes (V10-V19) may be used as ________ codes if: –Impacts current care or treatment secondary

26. Slide 26 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Special Note About “History of” Index to Disease, MAIN term “History” Entries between “family” and “visual loss _____” = “family history of” (FHO) Entries before “family” and after “visual loss” = “_______ history of” (PHO) Personal history = V__-V__ Family history = V__-V__ V19.0 personal 10 15 16 19

27. Slide 27 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guidelines L and M For patients receiving diagnostic services ONLY Sequence first –Diagnosis –Condition –Problem OR –Other reason shown in medical record to be chiefly responsible for encounter (…Cont’d)

28. Slide 28 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guidelines L and M (…Cont’d) Codes for other diagnoses (e.g., chronic conditions) –May be sequenced as _________ diagnoses Exception: Therapeutic Services –Patients receiving ____________ (V58.11), _______ ______ (V58.0), or rehabilitation (V57.0-V57.9) –V code first diagnosis and problem for which service being performed second secondary chemotherapy radiation therapy

29. Slide 29 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline N For patients receiving preoperative evaluations ONLY –Code from category _____ (Other specified examinations) –Assign secondary code for reason for surgery –Code also any findings related to preoperative evaluation V72.8

30. Slide 30 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline O, Ambulatory Surgery Code diagnosis which required ambulatory surgery Pre- and post-op diagnosis different –Code the ______ diagnosis post-op

31. Slide 31 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Diagnostic Guideline P Code routine prenatal visits with no complications: –_____ (Supervision of normal first pregnancy) –_____ (Supervision of other normal pregnancy) –DO NOT use these codes with pregnancy __________ codes (Chapter 11, ICD-9-CM) V22.0 V22.1 complication

32. Slide 32 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. V91 Multiple Gestation Placenta Status Identifies number of placentas and amniotic sacs for twins, triplets, quadruplets, other multiples

33. Slide 33 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Conclusion CHAPTER 9 ICD-9-CM OUTPATIENT CODING AND REPORTING GUIDELINES