1. Robyn Korn, MBA, RHIA, CPHQ HS225- Week 8 Overview of ICD-9-CM

2. ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification

3. Purpose ICD-9-CM Assigning of a numerical or alphanumerical characters to specific diagnoses Compile and present statistical data on: Morbidity Rate or frequency of disease Mortality Rate or frequency of deaths

4. Development of ICD-9-CM  Based on ICD-9  Developed by World Health Organization (WHO)  Revisions are published every 10 years  1948 - WHO assumed responsibility for revisions

5. Development 1950 – VA and US Public Health began studies to use ICD for hospital indexing 1956 – AHA and AMRL (now AHIMA) felt ICD was an efficient form of indexing for hospitals 1966 – WHO made 8 th revision

6. Development  1968 – ICDA – version adapted by the USA  1979 – ICD-9-CM replaced ICDA Intended for primary use in hospitals in USA  1988 – Medicare Catastrophic Coverage Act mandated use of ICD-9-CM for all Medicare claims Private insurance companies also required ICD-9-CM

7. Annual Updates National Center for Health Statistics (NCHS) Diagnostic codes – Volume 1 & 2 Centers for Medicare and Medicaid Services (CMS) Procedure codes – Volume 3

8. Volume 1 – Tabular List of Diseases and Injuries Classification of Diseases and Injuries – 17 chapters Organized by etiology (cause of the disease) or anatomical site (body system) Supplementary Classifications (V codes & E codes) Appendices A-E

9. V Codes Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (V01-V86) Reason for encounter when patient is not ill Factor affecting patient’s health status Medical Management of patient’s case Family and personal histories are coded to different V codes Located after Chapter 17 in code book Can stand alone as a diagnosis code

10. E codes Supplementary Classification of External Causes of Injury and Poisoning (E800-E999) Identify environmental event Circumstance or, Condition causing injury or poisoning Used in addition to diagnosis code Can not be stand alone

11. Appendices Appendix A – Morphology of Neoplasms Code range M8000/0 – M9970/1 Adapted from International Classification of Diseases of Oncology Appendix B – Glossary of mental disorders Deleted in October 1, 2004

12. Appendices Appendix C – Classification of Drugs by American Hospital Formulary Service List Number and Their ICD-9-CM Equivalents Appendix D – Classification of Industrial Accidents Removed October 2009 Appendix E – List of Three-Digit Categories

13. Volume 2 – Alphabetic Index Three Sections Index to Diseases and Injuries Alphabetic Index to Poisoning and External Cause of Adverse Effects of Drugs and Other Chemical Substances (Table of Drugs and Chemicals) Alphabetic Index to External Causes of Injury and Poisoning (E codes)

14. Volume 3 – Tabular List and Alphabetic Index of Procedures Used in Inpatient Hospitals only Format same as Volume 1 and 2 Organized by location of the procedure

15. Basic Coding Principal diagnosis -is defined in the Uniform Hospital Discharge Data Set (UHDDS) as “ that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.” Secondary diagnoses – complications or comorbidities

16. Diagnosis VS Procedure A diagnostic code classifies signs, symptoms, and diseases, or it indicates the reason the patient was seen. A procedure code is used to describe the treatment that was initiated or completed at an encounter.

17. Steps in Coding 1. Locate main term in Alpha Index (Volume 2) (disease, sign, symptom, condition or injury) 2. Scan main term entry for instruction notes 3. Identify any phrases that modify the main term (adjectives) 4. Follow any cross reference notes 5. Verify code in Tabular section (Volume 1) 6. Follow any instructional terms 7. Select the code

18. True/False 1. Volume 2 is the Tabular List of Diseases and Injuries. 2. V codes and E codes must be used with an additional code from the main chapters of ICD-9-CM. 3. Volume 3 is the Tabular List and Alphabetic Index of Procedures and is used in the facility setting. 4. E codes are used to code conditions or circumstances that are recorded as the reason for the patient encounter when the patient is not currently ill. 5. Family and personal histories of diseases are coded to different V codes.

19. True/False Answers 1. False 2. False 3. True 4. False 5. True

20. Fill in the Blank 1. The diagnostic chapters of ICD-9-CM are organized according to _______,the cause of disease, or ____________, the body system involved. 2. The ______________contains an alphabetical listing of the diseases and injuries found in ICD-9-CM and serves as a key to the coding system. 3. The codes that provide a classification for external causes of injuries and poisonings are known as _________________

21. Fill in the blank answer key 1. etiology, anatomical site 2. Alphabetic Index 3. E codes

22. ICD-10-CM/ ICD-10-PCS August 22, 2008 – proposed rule to replace ICD-9-CM with ICD-10-CM and ICD-10-PCS January 16, 2009 final rule adopted October 1, 2014 – possible implementation date of ICD-10- CM

23. Diagnosis Comparison ICD-9-CM 3-5 characters (mostly numeric) 13,000 codes Limited space for new diagnoses ICD-10-CM 3-7 characters (alpha and numeric) 68,000 codes Flexibility for adding new codes

24. Procedure Comparison ICD-9-CM 3-4 numbers in length 3,000 codes Limited space for adding new codes Generic body part terms ICD-10-PCS 7 alpha-numeric characters 87,000 codes Flexibility for adding new codes Detailed descriptions of body parts