1. Intro to ICD-9 Coding Nancy Clark, M.Ed. Director of Medical Informatics Education FSU College of Medicine

2. Class Resources Needed  ICD-9 Coding book Pages refer to Medicode book. Page numbers may not match other books.  A medical reference with ICD-9 codes Online ICD-9 coder at CDC WonderCDC  PDA Coding Programs InfoRetriever Epocrates ICD Bluefish RX ICD and CPT Bluefish RX ICD and CPT CodeMeister ICD Notes Pocket ICD/CPT StatICD, StatE&M, others StatICD, StatE&M, others ICD-9-CM pocket

3. Objectives  Learner will correctly describe a diagnosis so that a billing clerk can assign an ICD-9 code(s) to the encounter  Learner will correctly assign an ICD-9 code(s) to an encounter using the ICD-9 book  Learner will correctly assign an ICD-9 code(s) to an encounter using a computer program, PDA program or web site.

4. International Classification of Disease, 9th Revision  1948 - WHO developed to track diseases  1977 - 9th revision published  1988 - Congress passed Medicare Catastrophic Coverage Act requiring use of ICD-9 on all claims.  1996 - mandated codes be of highest possible specificity.

5. HCFA Guidelines  Identify each service, procedure, or supply with an ICD-9 code from 001.0 through V82.9 to describe the diagnosis, symptom, complaint, condition, or problem  Identify services or visits for circumstances other than disease or injury, such as follow-up care after chemotherapy, with V codes provided for this purpose.

6. HCFA Guidelines  Code the primary diagnosis first, followed by the secondary, tertiary and so on. Code any coexisting conditions that affect the treatment of the patient for that visit or procedure as supplementary information. Do not code a diagnosis that is no longer applicable.

7. HCFA Guidelines  Code to the highest degree of specificity. Carry the numerical code to the 4th or 5th digit when necessary. Remember, there are only approximately 100 valid three digit codes; all other ICD-9 codes require additional digits

8. HCFA Guidelines  Code a chronic diagnosis as often as it is applicable to the patient’s treatment at this encounter.  When only ancillary services are provided, list the appropriate V code first and the problem second.  For surgical procedures, code the diagnosis applicable to the procedure.

9. Anatomy of ICD-9 Code

10. Organization of ICD-9 Volume 1 001-139Infectious and Parasitic Diseases 140-239 Neoplasms 240-279Endocrine, Nutritional and Metabolic Diseases 280-289Diseases of the Blood and Blood-forming Organs 290-319Mental Disorders 320-389Diseases of the Nervous System and Sense Organs 390-459Diseases of the Circulatory System 460-519Diseases of the Respiratory System 520-579Diseases of the Digestive System 580-589Diseases of the Genitourinary System 630-676Complications of Pregnancy, Childbirth, and the Puerperium 680-709Diseases of the Skin and Subcutaneous Tissue

11. Organization of ICD-9 Volume 1 710-739Diseases of the Musculoskeletal System & Connective Tissue 740-759Congenital Anomalies 760-779Certain Conditions Originating in the Perinatal Period 780-799Symptoms, Signs and Ill-defined Conditions 800-999Injury and Poisoning E800-E999Supplementary Classification of the External Causes of Injury and Poisoning V01-V82Supplementary Classification of factors influencing Health Status and Contact with Health Services

12. Key to Symbols Additional Digits Required Nonspecific Code Not a Primary Diagnosis Not Elsewhere Classified Not Otherwise Specified NEC NOS EXCLUDES INCLUDES Symbols may vary with different books. Look for Key at beginning of Volume 1.

13. Volume 1 Structure

14. ICD-9 Volume 2  Section 1 - Alphabetic Index to Diseases  Section 2 - Table of Drugs and Chemicals  Section 3 - Index to External Causes  Handy Tables Hypertension Neoplasms

15. Using Book  Look up first 3 digits in Volume 2 Indices Pain, Chest 786.5

16. Using Book  Turn to that ICD code in Volume 1 786.5Chest pain 786.50Chest pain, unspecified 786.51Precordial pain 786.52Painful respiration Pain:Pleurodynia anterior chest wall pleuritic epidemic pleurodynia (074.1) 786.59Other Discomfort Pressurein chest Tightness EXCLUDES

17. New, Acute Problem, Diagnosable  Look up diagnosis in Volume 2  Go to Code # in Volume 1  Pick specific location, type, severity, complication, and/or manifestation  Find appropriate 4 th and 5 th digits Bronchitis, acute, probably viral 466.0

18. New Acute or Chronic Problem that you can’t diagnose this visit  Code the symptom Abdominal swelling or mass in epigastric area 789.36 Elevated blood pressure 796.2

19. Check-up for Chronic Problem, Well Child, Well Adult with No Complaints, Sequelae, or Complications  Use a V Code and/or Code for Chronic Problem  Look up Examination in Volume 2 Well Child v20.2 (EPSDT different) General Physical v70.0 Gynecological exam v72.3

20. More on Annual Physicals  Use Family History of … as second diagnosis when applicable to justify Family History of colon cancer V16.0

21. Follow-up for Previous Acute Condition, with no problems  Don’t Code for the acute condition which no longer exists  Use a V Code  Look up “History of” or “Aftercare” unless it was an accident Follow-up for pneumonia (fully healed) v12.6

22. Follow-up to Previous Acute Problem, there are complications  Look up “Late Effects” or the specific condition(s)  Patient develops infection in wound on hand you sutured three days ago 906.1

23. Chronic Problems with Sequelae  Requires two codes:  Code the Chronic Problem first  Code the Complication second Type 2 diabetic develops peripheral neuropathy Type 2 DM with neurological manifestations 250.60 Peripheral neuropathy 337.1

24. Accidents, Suicides, Poisonings... External Causes  Use E codes and/or Injury and Poisoning  Look up injury in Index, circumstances in E-Codes Elderly patient fell, sprained internal collateral ligament in ankle while stepping from curb: Sprains and strains of ankle and foot 845.01 Fall on or from sidewalk curb E880.1

25. Drug Side-Effects  Use Section 2 of Volume 2, p353  Will require 3 codes: the side effect, the code for poisoning for the drug and the E- code for the therapeutic use of the drug. Patient develops hives after taking penicillin Allergic urticaria 708.0 Penicillin poisoning 960.0 Therapeutic penicillin E930.0

26. Using IT Coding Aids  Online ICD-9 Search at CDC WonderCDC Wonder  InfoRetriever on PDA, desktop or online ICD-9 Coding module 5 Minute Clinical Consult  Encoder Pro and Code-it-Fast Encoder Pro and Code-it-Fast  First Consultonline  Other PDA coding software Bluefish RX ICD and CPT Bluefish RX ICD and CPT CodeMeister ICD Notes Pocket ICD/CPT StatICD, StatE&M, others StatICD, StatE&M, others ICD-9-CM pocket

27. References and Resources 1. Sulkes, S. Coding and Documenting for Reimbursement. In: Coleman, W. (2001) Family Focused Behavioral Pediatrics. Lippincott Williams & Wilkins, Philadelphia, PA. Available at Books@OVID

28. Look up some diagnoses