1. ICD-9-CM with ICD-10 Coding Guidelines
Chapter 4
ICD-9-CM with ICD-10 Coding Guidelines

2. ICD-9-CM and ICD-10-CM Official Guidelines for Coding and Reporting
Rules developed by cooperating parties for ICD-9-CM and ICD-10-CM to accompany and complement official conventions and instructions provided within ICD-9-CM and ICD-10-CM
Companion to ICD-9-CM and ICD-10-CM
(continued)

3. ICD-9-CM and ICD-10-CM Official Guidelines for Coding and Reporting
Cooperating parties
American Hospital Association (AHA)
AHIMA
CMS
NCHS

4. HIPAA Alert!
HIPAA regulations require providers and third-party payers to adhere to ICD-9-CM Official Guidelines for Coding and Reporting
Violation of coding guidelines is violation of HIPAA
Effective October 1, 2013, ICD-10-CM/PCS replaces ICD-9-CM

5. Official Guidelines for Coding and Reporting
Four sections
Section I
Section II
Section III
Section IV

6. Historical Perspective
Bertillon International Statistical Classification of Causes of Death
ICD
ICD-9-CM
ICD-10-CM and ICD-10-PCS

7. General Guidelines
Use both Index to Diseases and Tabular List of Diseases
Locate term in Index to Diseases first and verify code in Tabular List of Diseases
Assign highest level of digits available

8. Guidelines
Signs and symptoms integral to disease should not be assigned as additional codes
Etiology and manifestation convention requires two codes to be reported to completely describe a single condition
(continued)

9. Guidelines Multiple coding Acute (or subacute) and chronic conditions
Use additional code
Code first
If applicable, code any causal condition first
Acute (or subacute) and chronic conditions
Combination code versus multiple code

10. Late Effect
Residual condition that develops after acute phase of illness or injury has ended
No time limit on reporting
Combination code assigned
e.g., painful cicatrix following severe burn to elbow, left-sided paralysis due to previous cerebrovascular accident (CVA)

11. Chapter-Specific Diagnosis Coding Guidelines
Principal diagnosis
Secondary diagnoses
First-listed diagnosis

12. Chapter 1: Infectious and Parasitic Diseases
ICD-9-CM:
ICD-10-CM: A00-B99
Organisms
Infections
(continued)

13. Chapter 1: Infectious and Parasitic Diseases
“Supplemental Classification of Factors Influencing Health Status and Contact with Health Services”
Human immunodeficiency virus (HIV)

14. HIV Positive Status Key terms HIV disease HIV infection HIV infected
Acquired immune deficiency syndrome (AIDS)

15. HIV HIV-related conditions and opportunistic infections
Sequence HIV code (ICD-9-CM: 042, ICD-10-CM: B20) first and then opportunistic infection code
Sequencing of HIV codes with admission for unrelated condition
(continued)

16. HIV
Asymptomatic HIV
Inconclusive HIV serology

17. Chapter 2: Neoplasms ICD-9-CM: 140-239 ICD-10-CM: C00-D499 Neoplasm
“New growths or tumors in which cell reproduction is out of control”
Benign
Malignant
(continued)

18. Chapter 2: Neoplasms Six classifications: Primary malignancy
Secondary malignancy
Carcinoma (CA) in situ
Benign
Uncertain behavior
Unspecified nature
(continued)

19. Chapter 2: Neoplasms Contiguous sites (overlapping sites)
Re-excision of tumors

20. Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders
ICD-9-CM:
ICD-10-CM: D50-D89
Diabetes mellitus
Type 1
Patient’s body unable to produce insulin
Type 2
Patient’s body unable to properly use insulin produced

21. Chapter 4: Diseases of the Blood and Blood-Forming Organs
ICD-9-CM:
ICD-10-CM: D50-D89
Hematopoiesis
Anemia
Red cell volume
Hemoglobin content
(continued)

22. Chapter 4: Diseases of the Blood and Blood-Forming Organs
Shape (morphology)
Purpura

23. Chapter 5: Mental Disorders
ICD-9-CM:
ICD-10-CM: F01-F99
WHO guidelines
When classifying behavioral disorders, organically based illnesses reported before functional illnesses
Within functional group, classify disorders as psychoses, neuroses, personality disorders, and others
(continued)

24. Chapter 5: Mental Disorders
WHO guidelines
When coding mental illnesses associated with physical conditions, assign as many codes as necessary to fully describe clinical picture
New for ICD-10-CM
Pain disorders in psychological factors

25. Chapter 6: Nervous System and Sense Organs
ICD-9-CM:
ICD-10-CM: G00-G99, H00-H95
Nervous system, including meninges
Central nervous system
Brain
Spinal cord
Peripheral nervous system

26. Chapter 7: Circulatory System
ICD-9-CM:
ICD-10-CM: I00-I99
Hypertension, hypertensive table
Malignant (accelerated)
Benign
Unspecified
(continued)

27. Chapter 7: Circulatory System
Cerebral infarction, stroke, CVA
Late effects of cerebrovascular disease
Myocardial infarction

28. Chapter 8: Respiratory System
ICD-9-CM:
ICD-10-CM: J00-J99
Nose, sinuses, pharynx, larynx, trachea, bronchi, and lungs
Chronic obstructive pulmonary disease
Refer to main term “obstruction”
(continued)

29. Chapter 8: Respiratory System
Pneumonia
Asthma (status asthmaticus)
Acute exacerbation

30. Chapter 9: Digestive System
ICD-9-CM:
ICD-10-CM: K00-K94
Major digestive organs include pharynx, esophagus, stomach, and intestines
Accessory (secondary) organs include salivary and parotid glands, jaw, and teeth
(continued)

31. Chapter 9: Digestive System
Structures that support digestive process are gallbladder, pancreas, and liver

32. Chapter 10: Genitourinary System
ICD-9-CM:
ICD-10-CM: N00-N99
Chronic kidney disease (CKD)
Kidney transplant status
ICD-9-CM: V42.0
ICD-10-CM: Z94.0
CKD with other conditions

33. Chapter 11: Pregnancy, Childbirth, and Puerperium
ICD-9-CM:
ICD-10-CM: O00-O9A
Conditions occurring during pregnancy, childbirth, and six weeks immediately following childbirth
Never report these codes on baby’s record
(continued)

34. Chapter 11: Pregnancy, Childbirth, and Puerperium
Outcome of delivery
ICD-9-CM: V27.0-V27.9
ICD-10-CM: Z37.1-Z37.9
(continued)

35. Chapter 11: Pregnancy, Childbirth, and Puerperium
ICD-9-CM: (ectopic or molar pregnancy)
ICD-10-CM: O00-O02
(continued)

36. Chapter 11: Pregnancy, Childbirth, and Puerperium
ICD-9-CM: 639 (complications following abortion and ectopic or molar pregnancy)
ICD-10-CM: O08
Fifth digits to identify abortive stage
Unspecified (0)
Incomplete (1)
Complete (2)
(continued)

37. Chapter 11: Pregnancy, Childbirth, and Puerperium
ICD-9-CM: (complications related to pregnancy)
(continued)

38. Chapter 11: Pregnancy, Childbirth, and Puerperium
ICD-9-CM: 650 (normal delivery)
ICD-10-CM: O80
Minimal or no assistance
Episiotomy permitted
Fetal manipulation not permitted
e.g., use of forceps
(continued)

39. Chapter 11: Pregnancy, Childbirth, and Puerperium
Except for ICD-10-CM, fifth digit required for current episode of care
Unspecified as to episode of care (0)
Delivered with or without mention of antepartum condition (1)
Delivered with mention of postpartum complication (2)
Antepartum condition or complication (3)
Postpartum condition or complication (4)

40. Chapter 12: Skin and Subcutaneous Tissue
ICD-9-CM:
ICD-10-CM: L00-L99
Epidermis, dermis, subcutaneous tissue, nails, sebaceous glands, sweat glands, hair, and hair follicles

41. Chapter 13: Musculoskeletal System and Connective Tissue
ICD-9-CM:
ICD-10-CM: M00-M99
Bones, muscles, cartilage, fascia, ligaments, synovia, tendons, and bursa
(continued)

42. Chapter 13: Musculoskeletal System and Connective Tissue
Localized osteoarthrosis
Primary
Unknown etiology
Secondary
Caused by external or internal injury

43. Chapter 14: Congenital Anomalies
ICD-9-CM:
ICD-10-CM: Q00-Q99
Classifies all conditions according to principal or defining defect rather than cause
Except for chromosome abnormalities
(continued)

44. Chapter 14: Congenital Anomalies
May be apparent at birth or hidden and identified sometime after birth
Codes may used throughout patient’s life

45. Chapter 15: Conditions Originating in Perinatal Period
ICD-9-CM:
ICD-10-CM: P00-P96
Perinatal period
Interval of time before, during, and up to 28 days following birth
Never report these codes for mother’s episode of care

46. Chapter 16: Symptoms, Signs, and Ill-Defined Conditions
ICD-9-CM:
ICD-10-CM: R00-R99
Includes symptoms, signs, and abnormal results of laboratory or other investigative procedures
(continued)

47. Chapter 16: Symptoms, Signs, and Ill-Defined Conditions
Key terms
Abnormal, abnormality
Decrease, decreased
Elevation
Findings, abnormal, without diagnosis

48. Chapter 17: Injury and Poisoning
ICD-9-CM:
ICD-10-CM: S00-T98
Injuries
Fractures
Burns
Adverse effects, poisonings, and toxic effects

49. Fractures Open/compound fracture Closed/simple fracture Comminuted
Depressed
Fissured
Greenstick
Impacted
(continued)

50. Fractures Closed/simple fracture Complicated Malunion (late effect)
Linear
Slipped epiphysis
Spiral fracture
Complicated
Malunion (late effect)

51. Burns ICD-9-CM: 940-949 ICD-10-CM: T20-T32 Classified according to:
Depth
First degree (erythema)
Second degree (blistering)
Third degree (full thickness)
(continued)

52. Burns Classified according to: Extent
Percentage of body surface
Agent (e.g., chemicals, fire, sun)
E codes assigned

53. Adverse Effects Also known as adverse reactions
Appearance of pathologic condition caused by ingestion or exposure to chemical substance properly administered or taken
e.g., allergic rash due to penicillin
Table of Drugs and Chemicals

54. Poisonings Occur as result of overdose
Wrong substance administered/taken or intoxication that involves combining prescribed drugs with nonprescribed drugs or alcohol
e.g., coma due to overdose of codeine
(continued)

55. Poisonings ICD-9-CM: 960-979 ICD-10-CM: T36-T65
Manifestation of poisoning

56. Toxic Effects ICD-9-CM: 980-989 ICD-10-CM: T51-T65
When someone ingests or comes into contact with harmful substance

57. V Codes ICD-9-CM: V01-V85 ICD-10-CM: A00-Y99
Supplementary Classification of Factors Influencing Health Status and Contact with Health Services
(continued)

58. V Codes
Classifies occasions when circumstances other than disease or injury recorded as diagnoses or problems
(continued)

59. V Codes Categories: Contact/exposure Inoculations and vaccinations
Status
History (of)
Screening
Observation
Aftercare
(continued)

60. V Codes Categories: Routine and administrative examinations
Follow-up
Donor
Counseling
Obstetrics and related conditions
Newborn, infant, and child
Routine and administrative examinations
Miscellaneous

61. E Codes ICD-9-CM: E800-E999 ICD-10-CM: V00-Y99
Supplemental Classification of External Causes of Injury and Poisoning
Classifies environmental events, circumstances, and conditions as cause of injury, poisoning, or other adverse effect
(continued)

62. E Codes
Reported in addition to code from Chapters 1-17 to indicate nature of condition