1. Chapter 1: Introduction to ICD-9-CM
ICD-9-CM Diagnostic & Reimbursement for Physician Services edition
Chapter 1:
Introduction to ICD-9-CM

2. Assigning a representation for that data
Coding is…
Classifying data
Assigning a representation for that data
Telling a story to the insurance company using numbers instead of letters.
Example: A zip code is the representation of the area in which a person lives.

3. Retrieval of information
Purposes of Coding
Retrieval of information
By diagnosis (why the patient is in the office)
By procedure (what was done to the patient)
Reimbursement- money received from insurance company for correct coding.

4. ICD-9-CM Resources for Coding
Volumes 1 & 2 are used to code diagnoses in office and hospital settings
Volume 3 is used for hospital procedure coding
This book is updated annually in October for all settings

5. Volume 2: Alphabetic Index
This is where you look first.
Volume 2 is divided into three major sections:
Index to Diseases and Injuries
Table of Drugs and Chemicals
Alphabetic Index to External Causes of Injury and Poisoning

6. Volume 1 Tabular Index This is where you look second.
Volume 1 contains the following major subdivisions:
Classification of Diseases and Injuries
Supplementary Classifications
V Codes
E Codes
Appendices

7. Volume 1-Tabular Index Volume 1 is divided into 17 chapters (000–999).
Each chapter is structured into the following subdivisions:
Sections
Categories
Subcategories
Subclassifications

8. Sections & Categories Sections Categories
A group of three-digit categories
Represent a single disease entity or a group of similar or closely related conditions
Example: Disorders of Thyroid Gland (240–246)
Categories
Consist of three digits
Example: Disorders of tooth development and eruption (520)

9. Subcategories & Fifth digit Subclassifications
Represented by fourth digit
4th digit provides more specificity or information regarding the condition’s etiology, site, or manifestation
Fifth digit subclassifications
The fifth digit adds greater specificity to certain fourth-digit codes.
Fifth-digit assignments and instructions appear at the beginning of a chapter, section, category, or subcategory in the ICD-9cm book

10. Coding to specificity
You must code to the highest level of specificity. Otherwise you won’t get paid!
Third-digit code must only be used when there is no subcategory or subclassification.
Fourth-digit code must only be used when there is no subclassification with it.
Watch for required fourth and fifth digits, there will be a shaded box to the left of the code with a 4 or 5 in the box. Look down to the bottom of the page for the description of the shaded box and what is needed.

11. Residual Subcategories
Allow every disease or condition to have a code
Code title includes “other,” “unspecified,” or “other and unspecified.”
Usually designated by fourth-digit 8 or 9
Do NOT use unspecified codes unless you really cannot find another code!

12. Appendices Look in your book for the different Appendices.
Morphology of Neoplasms
Classification of Drugs by AHFS List
Classification of Industrial Accidents according to Agency
List of three-digit categories
c/c Exclusion List

13. Index to Diseases and Injuries
Main terms
Subterms
Carryover lines
Nonessential modifiers
Eponyms
Neoplasm and hypertension tables
Table of Drugs and Chemicals

14. Main Terms & Subterms Main Terms Subterms
Set flush with the left margin of each column
In boldface type
Represent:
Diseases (influenza, bronchitis)
Conditions (fatigue, fracture)
Nouns (disease, syndrome)
Adjectives (double, large, kink)
Subterms
Indented under the main term to the right by one standard indentation
Alphabetical order under main term
Describe differences in condition such as anatomic site, cause, or clinical type

15. Carryover Lines Carryover Lines (page 14)
Needed for main terms or subterms because the number of words that fit on a single line of print is limited in the Alphabetic Index.
Indented two standard indents
Do not confuse with another subterm
Nonessential Modifiers (page 14-15)
Series of terms in parentheses that may follow a main term or subterm
Presence or absence of parenthetical terms has no effect on code assignment.
Word in parentheses may or may not appear in the diagnostic statement without affecting the code assignment.

16. Eponyms & Index Tables Eponyms Index Tables
The name of a disease, structure, operation, or procedure usually derived from the name of the person who discovered or described it first
May be found under eponymic name or under “Disease,” “Syndrome,” or “Disorder”
Index Tables
Main terms and subterms are arranged in tables instead of standard columns.
Hypertension Table
Neoplasm Table
Table of Drugs and Chemicals

17. Inclusion Notes Further define or provide an example of code(s)
They can appear at the beginning of a chapter or section.
The notes usually list other common phrases used to describe the same condition but it may not be an exhaustive list.
Because an inclusion list is not repeated, coder must look back to the beginning of the chapter, section, category, or subcategory
Look at page 18 for examples

18. Excludes Notes Appear in italicized print in a box
Provide a direction to code the particular condition listed elsewhere, usually with the code listed in the exclusion notes.
May have 3 different meanings.

19. Excludes 3 Meanings
1: Code under consideration cannot be assigned if the associated condition specified in the exclusion note is present.
See subcategory for an example
2: Condition may have to be coded elsewhere.
The etiology of the condition determines whether the code under review or the code suggested in the exclusion note should be assigned.
One or the other code is used but not both.
See category 603 for an example.
3: Note indicates additional code may be required to explain the condition.
The condition in the exclusion note is not included in the code under review.
If the condition specified in the exclusion note is present, the additional code should be assigned
See codes for example.

20. Instructional Notes Appear in the Tabular List and Alphabetic Index
Describe needed instruction to assign fifth digits
Provide additional coding instruction
Provide definition of terms
Alphabetic Index notes are boxed and in italic type. Tabular notes are located at various levels and are not boxed.
See page 20 for example.

21. Mandatory Multiple Code Assignment
Certain conditions require multiple coding with one code for the underlying condition (cause, etiology) and another code for the manifestation(s).
Instructions on the sequence of codes is listed as well and should be followed.
The Alphabetic Index identifies both codes with the second code in brackets.

22. Multiple Code Assignment
Mandatory coding
First code is the underlying condition.
Second code in brackets is the manifestation.
Both codes are assigned.
Sequence the codes in the order listed in Alphabetic Index.
Use additional code, if desired. Pg 21
Appears in the Tabular List
“If desired” should be ignored.
The use of an additional code may provide more complete information.
The additional code must be assigned if the health information provides supportive documentation.
Code first underlying condition. Pg 22
Appears in the Tabular List
Found under codes that should not be listed first or as a single code
The underlying condition and code number(s) appear after the phrase, “Code first.”
Used with codes that are in italicized print, which indicates that the code is not listed first or appears as a single code

23. Connecting Words Examples: Refer to page 23 for example
Appear in the Alphabetic Index
Indicate a relationship between conditions
Examples:
And – Secondary to
Associated with – With
Due to – With mention of
Refer to page 23 for example

24. Abbreviations, Page 23-24 Not Elsewhere Classified (NEC)
Used with ill-defined terms in the Tabular List to warn the coder that specified forms of the condition are coded differently
Can be used with terms for which a more specific code is unavailable, even if the diagnostic statement is very specific.
Not Otherwise Specified (NOS)
Equivalent of unspecified
Used in the Tabular List
Usually included with .9 codes
Diagnostic statement does not contain enough information to assign a more specific code

25. Punctuation, page 24-25 Parentheses ( ) Square Brackets [ ]
Enclose supplementary words or explanatory information that may or may not be present in the diagnosis or procedure statement
Words in parentheses do not affect the code number assigned.
These terms are called nonessential modifiers
Square Brackets [ ]
Only used in the Tabular List
Enclose synonyms, alternative wording, abbreviations, and explanatory phrases

26. More Punctuation Slanted Brackets [ ] page 25 Colon :
Appear only in the Alphabetic Index
Enclose a code that must be used in conjunction with the code immediately preceding it
Code in the slanted brackets is always listed second.
Code in the slanted brackets is the disease’s manifestation
Colon :
Used in the Tabular List
Appears after an incomplete term that needs one or more modifiers or adjectives in order to be assigned to a given category or code
See Category 204 for an example on page 26

27. Punctuation (continued)
Brace }
Appears in the Tabular List
Intended to simplify entries and save printing space by reducing repetitive wording
Connects a series of terms on the left or the right with a statement on the other side of the brace
A term on the left must appear with a term on the right before this code can be used
See page 26 for example.

28. Symbols Section Mark § Lozenge ■
Indicates a footnote or reference concerning this code appears on the page or preceding pages
Not all codebook publishers use the section mark. Some have substituted another symbol to alert the coder of special instructions
Lozenge ■
Found immediately preceding a fourth digit to indicate the code is unique to ICD-9-CM and does not correlate directly to ICD-9
Has no significance to coding
May not be found in all codebooks

29. Basic Steps in ICD-9-CM Coding
1. Identify all main terms.
2. Locate each main term in the Alphabetic Index.
3. Refer to any subterms indented under the main term.
4. Follow cross- reference instructions for codes not located under the main term.
5. Verify the code selected in the Tabular List
6. Read and be guided by any instructional terms in the Tabular List.
7. Assign codes to their highest level of specificity.

30. Signs and Symptoms
When a definitive diagnosis is not available, the chief complaint should be used for coding
Do not code diagnoses documented as “probable,” “suspected,” “questionable,” “rule out,(R/O)” or “working diagnosis.” Code symptoms to the highest degree of certainty for the visit
Chronic diseases requiring ongoing treatment may be reported as many times as the patient receives treatment