1. ICD-9 Coding
Chapter 6

2. Volumes The ICD-9 has three volumes Volume 1 Tabular list of diseases
Volume 2 Index to diseases
Volume 3 Index to procedures and tabular list of procedures
The National Center for Health Statistics and CMS are U.S. department of health and human service agencies responsible for overseeing all changes and modifications to the ICD-9-CM

3. ICD-9-CM
The Medicare Catastrophic Coverage Act of 1988 mandated the reporting of ICD-9-CM diagnosis codes on Medicare claims
Requiring diagnosis codes to be reported on submitted claims establishes the medical necessity of procedures and services rendered to patients

4. ICD-9-CM
If it is possible that scheduled tests, services, or procedures may be found medically unnecessary by Medicare the patient must sign an advance beneficiary notice ABN (advanced beneficiary notice) which acknowledges patient responsibility for payment if Medicare denies the claim
The ICD-9-CM is updated annually

5. ICD-9-CM
An encoder automates the coding process using computerized or web-based software, instead of manually looking up conditions
Medical necessity is the measure of whether a healthcare procedure or service is appropriate for the diagnosis and/or treatment of a condition

6. ICD-10-PCS
The ICD-10-PCS is an entirely new procedure classification system developed by the Centers for Medicare and Medicaid Services for use in the United States for inpatient hospital settings only and will replace Volume 1, Volume 2, and Volume 3 of the ICD-9-CM on October 1, 2013

7. Outpatients Outpatients may be classified as the following:
Ambulatory surgery centers 23 hours 59 minutes 59 seconds
Healthcare providers office
Hospital clinic, emergency department, same day surgery unit 23 hours 59 minutes 59 seconds
Hospital observation 23 hours 59 minutes 59 seconds

8. Inpatient
An inpatient is an individual admitted to a hospital or long-term care facility for treatment with the expectation that the patient will remain in the hospital for 24 hours or longer
Inpatient principal diagnosis is defined as the condition determined AFTER study which resulted in the patients admission to the hospital

9. Comorbidity & Complication
Comorbidity is a concurrent condition that coexists with the first listed diagnosis or principal diagnosis and is an active condition for which the patient is treated and/or monitored
Complication condition that develops after outpatient care has been provided

10. Accurate Reporting
For accurate reporting of ICD-9-CM diagnosis codes, the documentation should describe the patients condition using terminology that includes specific diagnoses as well as symptoms, problems, or reasons for the encounter

11. Level of Detail in Coding
ICD-9-CM codes contain three, four, or five digits.
Three digit disease it to be assigned if it is not further subdivided
If fourth digit code (subcategories) or fifth digit codes (subclassifications) are provided they must be assigned
A code is invalid if it has not been coded to the full number of digits required for that code

12. Encounter/Visit
Report first the ICD-9-CM code for the diagnosis, condition, or problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the services provided
Do NOT code diagnoses documented as probable, suspected, questionable, rule out or working diagnosis

13. Chronic Diseases
Chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient receives treatment and care for the conditions
Do not code conditions that were previously treated and no longer exist

14. Appendices Appendix A – Morphology of Neoplasms M Codes
Appendix C- Classification of Drugs by American Hospital Formulary Service
Appendix D- Classification of Industrial Accidents According to Agency
Appendix E List of three digit categories

15. V Codes & E Codes
V Codes are located in the Tabular List of Disease and are assigned for patient encounters when a circumstance other than a disease or injury is present
E Codes also located in the Tabular List of Disease, describe external causes of injury, poisonings, or other adverse reactions affecting a patients health

16. Terms
Main terms are printed in boldface type and are followed by the code number
Nonessential modifiers are supplementary words located in parentheses after a main term
Subterms or essential modifiers qualify the main term by listing alternate sites, etiology, pr clinical status

17. Exercise 6.1 Break for Exercise 6.1 1. bronchiole spasm 519.11
2. congenital candidiasis
3. Irritable Bladder
4. Earthquake Injury E909.0
5. Exposure to AIDS V01.79

18. Codes in Slanted Brackets & Categories
Codes in slanted brackets are always listed as secondary codes because they are manifestations of other conditions
Categories are printed in bold upper and lower case type and are preceded by three digit code Ex 395
Subcategories are indented and printed in the same fashion and are four digit code 401.9
Subclassifications require a fifth digit

19. Exercise 6.2 & 6.3 Break for Exercise 6.2-6.3
1. Fracture mandible
2. Actinomycotic meningitis 039.8/320.7
3. Psychomotor akinetic epilepsy
6.3
postinflammatory pulmonary fibrosis C
type II diabetes E

20. Principal & Secondary Procedure
Principal procedure performed for definitive treatment rather than diagnostic purposes
Secondary procedure are additional procedures performed during the same encounter as the principal procedure

21. Neoplasms
Neoplasms are new growths, or tumors, in which cell reproduction is out of control. The provider should specify whether the tumor is benign, malignant, or in situ
Primary malignancy original tumor site
Carcinoma in Situ malignant tumor that is localized and has NOT spread

22. Exercises 6.4-6.6 Break for Exercise 6.4
1. Benign neoplasm, ear cartilage 215.0
2. cervicitis, tuberculous
3. Diabetic cataract
6.5
1. Essential hypertension
6.6
1. kaposi’s sarcoma
2. carcinoma in situ, skin, left cheek 232.3

23. Malignancies
Secondary malignancies are metastatic and indicate that a primary cancer has spread (metastasized) to another part of the body
Re-excision is preformed to ensure that all tumor cells have been removed and that a clear border of normal tissue surrounds the excised specimen

24. Table of Drugs and Chemicals
The table of drugs and chemicals is used to identify drugs or chemicals that cause poisonings and adverse effects
Adverse effect is the appearance of a pathologic condition caused by ingestion or exposure to a chemical substance properly administered or taken

25. Exercises 6.7 & Exercise 6.8 6.7 1. Carcinoma of the lung 162.9
2. Carcinoma of the breast with metastasus to the axillary lymph nodes
6.8
1. Adverse reaction to pertussis vaccine
978.6 E948.6

26. Supplementary Classifications
V codes and E codes are supplementary classifications
V codes factors influencing health status and contact with health services (history, exposure, well baby check up, physical examination)
E code external causes of injury and poisonings

27. Main Terms V Codes Check up Encounter Exposure Follow up
Family/social history
Observation
Routine examination
Screening

28. Exercise 6.9 & 6.10
6.9
1. family history of epilepsy with no evidence of seizures v17.2
6.10
1. Patient is HIV positive with no symptoms V08
2. Open fracture maxilla

29. BURNS
Burns require two codes: one for the site and degree and a second for the % of body surface affected
Head and neck 9%
Back
18%
Chest
Leg each
Leg
Arm each
Arm
Genitalia 1%

30. ICD-9-CM
Congenital anomalies are disorders diagnosed in infants at birth
Perinatal conditions occur before birth, during birth, or within the perinatal period or the first 28 days of life

31. Exercise 6.11
6.11
1. maluninon due to fracture, right ankle, 9 months ago
2. third degree burn, back, 18 % body surface

32. E Codes
An E code consists of a four character number and one digit after a decimal point
Reporting E codes on claims can expedite payment by health insurance carriers when no third party liability for an accident exists

33. Exercise 6.12
6.12
1.Automobile accident, highway, passenger
E819.1