1. Copyright © 2008 Delmar Learning. All rights reserved. Chapter 6 ICD-9-CM Coding

2. Copyright © 2008 Delmar Learning. All rights reserved. 2 ICD-9-CM Coding International Classification of Diseases (ICD) –Used to code and classify mortality (death) data from death certificates

3. Copyright © 2008 Delmar Learning. All rights reserved. 3 ICD-9-CM Coding International Classification of Diseases, Clinical Modification (ICD-9-CM) – Used to code and classify morbidity (disease) data from inpatient and outpatient records

4. Copyright © 2008 Delmar Learning. All rights reserved. 4 Overview of ICD-9-CM ICD-9-CM is organized into three volumes: –Volume 1 Tabular List –Volume 2 Index to Diseases –Volume 3 Index to Procedures and Tabular List

5. Copyright © 2008 Delmar Learning. All rights reserved. 5 Mandatory Reporting of ICD-9-CM Codes Medicare Catastrophic Coverage Act of 1988 –Mandated reporting of ICD-9-CM diagnosis codes on Medicare claims

6. Copyright © 2008 Delmar Learning. All rights reserved. 6 Mandatory Reporting of ICD-9-CM Codes Medical necessity: –Determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury

7. Copyright © 2008 Delmar Learning. All rights reserved. 7 ICD-9-CM Annual Updates CMS enforces regulations pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) –Requires all code sets reported on claims be valid at the time services are provided

8. Copyright © 2008 Delmar Learning. All rights reserved. 8 ICD-9-CM Annual Updates Compliance means: –Traditional mid-year (April 1) and end-of- year (October 1) coding updates Must be immediately implemented so that accurate codes are reported on submitted claims

9. Copyright © 2008 Delmar Learning. All rights reserved. 9 ICD-9-CM Annual Updates If outdated codes are submitted on claims: –Providers and health care facilities will incur administrative costs associated with resubmitting corrected claims and delayed reimbursement for services provided

10. Copyright © 2008 Delmar Learning. All rights reserved. 10 Outpatient Coding Guidelines Diagnostic Coding and Reporting Guidelines for Outpatient Services: Hospital-Based and Physician Office –Developed by the federal government for use in reporting diagnoses for claims submission

11. Copyright © 2008 Delmar Learning. All rights reserved. 11 Outpatient Coding Guidelines Developed and approved by: 1.American Hospital Association (AHA) 2.American Health Information Management Association (AHIMA) 3.Centers for Medicare and Medicaid Services (CMS, formerly HCFA) 4.National Center for Health Statistics (NCHS)

12. Copyright © 2008 Delmar Learning. All rights reserved. 12 Outpatient Coding Guidelines Although the guidelines were originally developed for use in submitting government claims, insurance companies have also adopted them.

13. Copyright © 2008 Delmar Learning. All rights reserved. 13 Coding Tip Most critical rule involves beginning the search for the correct code assignment using the Index to Diseases/of Diseases.

14. Copyright © 2008 Delmar Learning. All rights reserved. 14 Selection of First-Listed Condition In the outpatient setting: –Term first-listed diagnosis is used –Determined in accordance with ICD-9-CM’s coding conventions as well as general and disease-specific coding guidelines

15. Copyright © 2008 Delmar Learning. All rights reserved. 15 Selection of First-Listed Condition Outpatient treated in one of four settings: 1.Ambulatory Surgery Center (ASC) –Patient is released prior to a 24-hour stay 2.Health care provider’s office

16. Copyright © 2008 Delmar Learning. All rights reserved. 16 Selection of First-Listed Condition Outpatient treated in one of four settings: 3. Hospital clinic, emergency or outpatient department, or same-day surgery unit 4. Hospital observation setting Patient’s length of stay is 23 hours, 59 minutes, and 59 seconds or less

17. Copyright © 2008 Delmar Learning. All rights reserved. 17 Coding Tip Outpatient surgery: –Code reason for surgery as the first-listed diagnosis (reason for the encounter) Even if surgery is not performed due to a contradiction

18. Copyright © 2008 Delmar Learning. All rights reserved. 18 Coding Tip Observation stay: –When a patient is admitted for observation for a medical condition, assign a code for the medical condition as the first-listed diagnosis

19. Copyright © 2008 Delmar Learning. All rights reserved. 19 Coding Tip Outpatient surgery requires longer stay: –A patient presents for outpatient surgery and develops complications requiring admission to observation. –Code the reason for the surgery as the first reported diagnosis, followed by codes for the complications as secondary diagnoses.

20. Copyright © 2008 Delmar Learning. All rights reserved. 20 Coding Tip An inpatient is a person admitted to a hospital or long term care facility for treatment with an expected stay of 24 hours or more.

21. Copyright © 2008 Delmar Learning. All rights reserved. 21 Coding Tip In medical literature, you may see principal diagnosis referred to as first-listed diagnosis. Remember! –The outpatient setting’s first-listed diagnosis is not the principal diagnosis

22. Copyright © 2008 Delmar Learning. All rights reserved. 22 Inpatient principal diagnosis: –Condition determined after study that resulted in the patient’s admission to the hospital. UB-04 secondary diagnoses include co- morbidities and complications Coding Tip

23. Copyright © 2008 Delmar Learning. All rights reserved. 23 ICD-9-CM Tabular List of Diseases (codes 001.0-V86.1) Must be used to identify diagnoses, symptoms, conditions, problems, complaints, or any other reason for the encounter/visit.

24. Copyright © 2008 Delmar Learning. All rights reserved. 24 Accurate Reporting of ICD-9-CM Diagnosis Codes Documentation should describe patient’s condition using terminology that includes specific diagnoses as well as symptoms, problems, or reasons for the encounter.

25. Copyright © 2008 Delmar Learning. All rights reserved. 25 ICD-9-CM Tabular List of Diseases (codes 001.0-V86.1) Must be used to identify diagnoses, symptoms, conditions, problems, complaints, or any other reason for the encounter/visit.

26. Copyright © 2008 Delmar Learning. All rights reserved. 26 Reason for Encounter Codes 001.0–999.9 –Frequently used to describe reason for encounter –Codes are from section of ICD-9-CM for the classification of diseases and injuries.

27. Copyright © 2008 Delmar Learning. All rights reserved. 27 Signs and Symptoms Codes that describe signs and symptoms are acceptable for reporting purposes when the physician has not documented an established or confirmed diagnosis.

28. Copyright © 2008 Delmar Learning. All rights reserved. 28 Factors Influencing Health Status and Contact with Health Services (V codes) Provides codes to deal with encounters for circumstances other than a disease or injury Codes V01.0-V86.1

29. Copyright © 2008 Delmar Learning. All rights reserved. 29 Level of Detail in Coding Codes contain 3, 4, or 5 digits Codes with three digits: –Included in ICD-9-CM as the heading of a category of disease codes –May be further subdivided into four or five digits Provide greater specificity

30. Copyright © 2008 Delmar Learning. All rights reserved. 30 Level of Detail in Coding Three-digit disease code is assigned only if it is not further subdivided If fourth-digit subcategories or fifth-digit subclassifications are provided: –They must be assigned If not the code is invalid

31. Copyright © 2008 Delmar Learning. All rights reserved. 31 Sequencing ICD-9-CM Diagnosis First code for the diagnosis, condition, problem, or other reason for encounter shown in the medical record to be chiefly responsible for the services provided.

32. Copyright © 2008 Delmar Learning. All rights reserved. 32 Sequencing ICD-9-CM Diagnosis Additional codes that describe coexisting conditions that were treated or medically managed during the encounter.

33. Copyright © 2008 Delmar Learning. All rights reserved. 33 Qualified Diagnoses Do not code diagnoses documented as: –Probable, suspected, questionable, rule out, or working diagnosis, because these are considered qualified diagnoses Instead code condition to highest degree of certainty for that encounter

34. Copyright © 2008 Delmar Learning. All rights reserved. 34 Qualified Diagnoses Qualified diagnosis: –Working diagnosis that is not yet proven or established –Example: Suspected pneumonia Code the sign or symptom: –Wheezing, shortness of breath, etc.

35. Copyright © 2008 Delmar Learning. All rights reserved. 35 Chronic Diseases If treated on an ongoing basis: –May be coded and reported as many times as the patient receives treatment and care for the condition

36. Copyright © 2008 Delmar Learning. All rights reserved. 36 Code all Documented Conditions that Coexist Code all that coexist at the time of the encounter, and require or affect patient care, treatment or management.

37. Copyright © 2008 Delmar Learning. All rights reserved. 37 Code all Documented Conditions that Coexist Do not code conditions that were previously treated and no longer exist. However, history codes (V10-V19) may be reported as secondary codes.

38. Copyright © 2008 Delmar Learning. All rights reserved. 38 Encounter for Diagnostic Services First, report the diagnosis, condition, problem, or reason for encounter that is documented in the patient record as being chiefly responsible for the outpatient services provided during the encounter.

39. Copyright © 2008 Delmar Learning. All rights reserved. 39 Encounter for Therapeutic Services Sequence first the diagnosis, condition, problem, or other reason for the encounter shown in the medical record to be chiefly responsible for the outpatient services provided.

40. Copyright © 2008 Delmar Learning. All rights reserved. 40 Encounter for Preoperative Evaluation Assign appropriate sub classification code located under subcategory V72.8.

41. Copyright © 2008 Delmar Learning. All rights reserved. 41 ICD-9-CM Coding System ICD-9-CM has three volumes: –Tabular List –Index to Diseases –Index to Procedures and Tabular List

42. Copyright © 2008 Delmar Learning. All rights reserved. 42 ICD-9-CM Coding System Tabular and Index to Diseases –Used in provider and health facilities to code diagnoses Index to Procedures and Tabular List –Used in hospitals to code inpatient procedures

43. Copyright © 2008 Delmar Learning. All rights reserved. 43 ICD-9-CM Coding System Publishers make coding easier by placing the Index to Diseases in front of the Tabular List

44. Copyright © 2008 Delmar Learning. All rights reserved. 44 Supplementary Classifications: V Codes and E Codes V codes are assigned when a circumstance other than a disease or injury is present. –Examples: Removal of cast applied by another physician (V54.89) Exposure to tuberculosis (V10.3)

45. Copyright © 2008 Delmar Learning. All rights reserved. 45 V Codes and E Codes Like V codes, E codes are located in the Tabular List: –E codes describe external causes of injury, like poisoning, accidents, or other adverse reactions affecting a patient’s health

46. Copyright © 2008 Delmar Learning. All rights reserved. 46 Appendices Appendices serve in coding neoplasms, adverse effects of chemicals and drugs, and external causes of disease and injury. In addition, the disease category codes are listed as an appendix.

47. Copyright © 2008 Delmar Learning. All rights reserved. 47 Appendices Morphology of Neoplasms (M codes) contains a reference to the World Health Organization publication entitled International Classification of Diseases for Oncology.

48. Copyright © 2008 Delmar Learning. All rights reserved. 48 Appendices Morphology –Indicates tissue type of a neoplasm Benign –Not cancerous Malignant –Cancerous

49. Copyright © 2008 Delmar Learning. All rights reserved. 49 Appendices Classification of Drugs by AHFS list contains the American Hospital Formulary Services list number and its ICD-9-CM code number –Organized in numerical order according to AHSF list number

50. Copyright © 2008 Delmar Learning. All rights reserved. 50 Appendices Classification of industrial accidents according to agency based on employment injury statistics –Adopted by the International Conference of Labor Statisticians Difficult to locate the E code entry in the ICD-9-CM Index to External Causes

51. Copyright © 2008 Delmar Learning. All rights reserved. 51 Appendices List of three-digit categories contains a breakdown of three-digit category codes organized beneath section headings.

52. Copyright © 2008 Delmar Learning. All rights reserved. 52 Index to Diseases Within the ICD-9CM Index to Diseases –Two official tables that make it easier to code hypertension and neoplasms

53. Copyright © 2008 Delmar Learning. All rights reserved. 53 Great Tools Within the ICD-9-CM index Table of Drugs and Chemicals Index to External Causes (E codes)

54. Copyright © 2008 Delmar Learning. All rights reserved. 54 Volume 3: Index to Procedures and Tabular List Included in hospital version of commercial ICD-9-CM books Index to Diseases alphabetical listings of main terms or conditions

55. Copyright © 2008 Delmar Learning. All rights reserved. 55 Volume 3: Index to Procedures and Tabular List Main terms –Printed in boldface type and are followed by the code number Subterms (essential modifiers) –Qualify the main term by listing alternate sites, etiology, or clinical status

56. Copyright © 2008 Delmar Learning. All rights reserved. 56 Volume 3: Index to Procedures and Tabular List Step 1 –Locate main term in the Index to Diseases

57. Copyright © 2008 Delmar Learning. All rights reserved. 57 Volume 3: Index to Procedures and Tabular List Step 2 –If the phrase “see condition” is found after the main term: A descriptive term (an adjective) or the anatomic site has been referenced instead of the disorder

58. Copyright © 2008 Delmar Learning. All rights reserved. 58 Volume 3: Index to Procedures and Tabular List Referenced instead of the disorder or the disease (the condition) documented in the diagnostic statement.

59. Copyright © 2008 Delmar Learning. All rights reserved. 59 Volume 3: Index to Procedures and Tabular List Step 3 –When the condition listed cannot be found: Locate main terms such as syndrome, disease, disorder, derangement of, or abnormal. See Table 6-1 that lists special main terms for additional help.

60. Copyright © 2008 Delmar Learning. All rights reserved. 60 Volume 3:Index to Procedures and Tabular List Major Topic Headings –Printed in bold uppercase letters and followed by codes in parentheses

61. Copyright © 2008 Delmar Learning. All rights reserved. 61 Volume 3: Index to Procedures and Tabular List Categories –Major topics are divided into three-digit categories Printed in upper and lower case and are followed by three-digit codes

62. Copyright © 2008 Delmar Learning. All rights reserved. 62 Volume 3: Index to Procedures and Tabular List Subcategories –Four-digit subcategories are indented and printed in the same way as major category headings.

63. Copyright © 2008 Delmar Learning. All rights reserved. 63 Volume 3: Index to Procedures and Tabular List Subclassifications –Some fourth digits are more subdivided into subclassifications, which require the task of a fifth digit.

64. Copyright © 2008 Delmar Learning. All rights reserved. 64 Volume 3: Index to Procedures and Tabular List Fifth-digits –Required when indicated in the code book

65. Copyright © 2008 Delmar Learning. All rights reserved. 65 Volume 3: Index to Procedures and Tabular List Fifth-digit entries are associated with: –Chapters –Major topic headings –Categories –Subcategories

66. Copyright © 2008 Delmar Learning. All rights reserved. 66 Using the Tabular List After reviewing main terms and subterms: –Locate the first possible code in the Index to Disease

67. Copyright © 2008 Delmar Learning. All rights reserved. 67 Using the Tabular List In the Tabular List: –Locate code, review code descriptions, review any EXCLUDES notes to determine whether the condition being coded is excluded Assign any required fifth digit

68. Copyright © 2008 Delmar Learning. All rights reserved. 68 Using the Tabular List Check to be sure the code number is appropriate for age and sex of patient Return to Index to Disease for other possible code selections –If code description does not fit condition or reason for visit Enter final code

69. Copyright © 2008 Delmar Learning. All rights reserved. 69 Tabular List (Disease) Coding Conventions Apply to disease and condition codes and to additional classification codes Index to Procedures and Tabular List: –Included only in hospital version of commercial ICD-9-CM books

70. Copyright © 2008 Delmar Learning. All rights reserved. 70 Tabular List (Disease) Coding Conventions Principal Procedures –A procedure performed for best treatment before diagnostic purpose –One performed to treat a problem –One that is most closely related to principal diagnosis

71. Copyright © 2008 Delmar Learning. All rights reserved. 71 Tabular List (Disease) Coding Conventions Secondary Procedure –Additional procedures performed during same encounter as the principal procedure

72. Copyright © 2008 Delmar Learning. All rights reserved. 72 Tabular List (Disease) Coding Conventions Benign –Mild and/or controlled hypertension Unspecified –No notation of benign or malignant status

73. Copyright © 2008 Delmar Learning. All rights reserved. 73 Neoplasm Table Neoplasms –New growths or tumors, where cell reproduction is out of control –Provider should specify whether the tumor is benign or malignant

74. Copyright © 2008 Delmar Learning. All rights reserved. 74 Neoplasm Table Another term related with neoplasm is lesion –Defined as any discontinuity of tissue

75. Copyright © 2008 Delmar Learning. All rights reserved. 75 Neoplasm Table Mass Cyst Dysplasia Polyp Adenosis

76. Copyright © 2008 Delmar Learning. All rights reserved. 76 Neoplasm Table Primary Malignancy –Original tumor site –All malignant tumors are considered primary Unless otherwise documented as metastatic or secondary

77. Copyright © 2008 Delmar Learning. All rights reserved. 77 Neoplasm Table Secondary Malignancy –Tumor has spread to a secondary site Either nearby the primary site or to a distant area of the body

78. Copyright © 2008 Delmar Learning. All rights reserved. 78 Neoplasm Table Carcinoma (Ca) in SITU –Tumor that is localized, limited, encapsulated, and noninvasive

79. Copyright © 2008 Delmar Learning. All rights reserved. 79 Neoplasm Table Uncertain behavior –Pathology impossible to predict subsequent morphology or behavior from the submitted specimen

80. Copyright © 2008 Delmar Learning. All rights reserved. 80 Neoplasm Table Unspecified nature –Neoplasm is identified But no more signs of histology or nature of the tumor is in the document diagnosis

81. Copyright © 2008 Delmar Learning. All rights reserved. 81 Neoplasm Table Primary Malignancies –Malignancy is coded as the primary site if the diagnostic statement documents: Metastatic from a site Spread from a site Primary neoplasm of a site

82. Copyright © 2008 Delmar Learning. All rights reserved. 82 Neoplasm Table Malignancy for which no specific classification is documented –Recurrent (repeating) tumor

83. Copyright © 2008 Delmar Learning. All rights reserved. 83 Secondary Malignancies –Metastatic and show that a primary cancer has spread to another

84. Copyright © 2008 Delmar Learning. All rights reserved. 84 Secondary Malignancies Cancer described as metastatic from a site is primary of that site: –Assign code to the primary neoplasm –Assign second code to the secondary neoplasm of the specified site, or unspecified site

85. Copyright © 2008 Delmar Learning. All rights reserved. 85 Secondary Malignancies Cancer described as metastatic to a site is considered secondary of that site –Assign one code to the secondary site, and a second code to the specified primary site or unspecified site.

86. Copyright © 2008 Delmar Learning. All rights reserved. 86 Secondary Malignancies When anatomic sites are recognized as metastatic: –Assign secondary neoplasm code(s) to those sites –Assign unspecified site code to the main malignant neoplasm

87. Copyright © 2008 Delmar Learning. All rights reserved. 87 Secondary Malignancies If the diagnostic statement does not specify whether the neoplasm site is primary or secondary: –Code site as primary unless the documented site is the following….

88. Copyright © 2008 Delmar Learning. All rights reserved. 88 Secondary Malignancies Bone, brain, diaphragm, heart, liver, lymph nodes, mediastinum, meninges, peritoneium, pleura,retropertoneum, spinal cord,or classifiable to 195.

89. Copyright © 2008 Delmar Learning. All rights reserved. 89 Re-excision of Tumor When a surgeon performs a second excision to widen the margins of the original tumor site –Ensures that all tumor cells have been removed

90. Copyright © 2008 Delmar Learning. All rights reserved. 90 Coding Tip Read notes that apply to condition you are coding Never assign a code directly from table or Index to Diseases Be certain codes represent current status of the neoplasm

91. Copyright © 2008 Delmar Learning. All rights reserved. 91 Coding Tip Assign a neoplasm code if tumor has been excised –And patient is still undergoing radiation or chemotherapy Assign a V code if tumor is not present –If patient is not receiving treatment but is returning for follow-ups

92. Copyright © 2008 Delmar Learning. All rights reserved. 92 Coding Tip In a pathology report: –Classification stated overrides morphology classification in the Index to Diseases Poisonings occur as a result of an overdose, wrong substance administered or taken, or intoxication.

93. Copyright © 2008 Delmar Learning. All rights reserved. 93 Poisoning and External Cause Poisoning –Codes 960-989 Assigned according to classification of drug or chemical

94. Copyright © 2008 Delmar Learning. All rights reserved. 94 Poisoning and External Cause Accident –Codes (E850-E869) Accidental overdosing Wrong substance given Drug inadvertently taken Accidents during a medical surgical procedure

95. Copyright © 2008 Delmar Learning. All rights reserved. 95 Poisoning and External Cause Therapeutic use –Codes E930-E952 Effect caused by proper substance administered in therapeutic setting Suicide attempt –Codes E950-E952 Self-inflicted poisoning

96. Copyright © 2008 Delmar Learning. All rights reserved. 96 Poisoning and External Cause Assault –Codes E961-E962

97. Copyright © 2008 Delmar Learning. All rights reserved. 97 Poisoning and External Cause Undetermined –Codes E980-E982 If used it will not state whether poisoning was intentional or accidental. E codes are used to explain cause of poisoning or effect

98. Copyright © 2008 Delmar Learning. All rights reserved. 98 Poisoning and External Cause ICD-9-CM contains two supplementary classifications: – V codes Factors influencing health status and contact. (V01-V82) –E codes External causes of injury and poisoning (E800- E999)

99. Copyright © 2008 Delmar Learning. All rights reserved. 99 V Codes Classification of factors influencing the person’s health status These services fall into one of these categories: –Problems Issues that could affect patient’s health status

100. Copyright © 2008 Delmar Learning. All rights reserved. 100 V Codes Services –Patient seen for treatment not caused by illness Factual reporting –Used for statistical purpose

101. Copyright © 2008 Delmar Learning. All rights reserved. 101 V Code and Description V01-V06 –Persons with potential health hazards related to communicable diseases V07-V09 –Persons with need for isolation, other health hazards, and prophylactic measures

102. Copyright © 2008 Delmar Learning. All rights reserved. 102 V Code and Description V10-V19 –Person with potential health related to personal or family history

103. Copyright © 2008 Delmar Learning. All rights reserved. 103 V Code and Description V20-V29 –Persons encountering services in circumstances related to reproduction and development V30-V39 –Live born infants according to type of birth

104. Copyright © 2008 Delmar Learning. All rights reserved. 104 V Code and Description V40-V49 –Person with a condition influencing their health

105. Copyright © 2008 Delmar Learning. All rights reserved. 105 V Code and Description V50-V59 –Encountering health services for specific procedures and aftercare V60-V69 –Encountering health services in other circumstances

106. Copyright © 2008 Delmar Learning. All rights reserved. 106 V Code and Description V70-V83 –Person without reported diagnosis encountered during examination and investigation of individuals and population Code 042 –States that patient is HIV and associated with AIDS

107. Copyright © 2008 Delmar Learning. All rights reserved. 107 V Code and Description Code 079.53 –When HIV is identified by provider Code 795.71 –When screening for HIV was reported as nonspecific V01.7 –Patient exposed to virus but not tested

108. Copyright © 2008 Delmar Learning. All rights reserved. 108 V Code and Description V08 –Assigned when patient is HIV positive but not showing symptoms

109. Copyright © 2008 Delmar Learning. All rights reserved. 109 Common Closed Fractures Comminuted Linear Spiral Impacted Simple Greenstick

110. Copyright © 2008 Delmar Learning. All rights reserved. 110 Common Open Fracture Compressed Compound Missile Puncture Fracture with a foreign body Infected fracture

111. Copyright © 2008 Delmar Learning. All rights reserved. 111 Late Effect Residual effect of a previous acute illness or long-term effect of the disorder

112. Copyright © 2008 Delmar Learning. All rights reserved. 112 Two Codes Needed Primary code –Identifies original illness Secondary –Represents original condition of the late effect

113. Copyright © 2008 Delmar Learning. All rights reserved. 113 Original Condition Fracture CVA Third-degree burn Polio Laceration Breast implant

114. Copyright © 2008 Delmar Learning. All rights reserved. 114 Late Effect Malunion Hemiplegia Deep scarring Contractures Keloid Ruptured implant

115. Copyright © 2008 Delmar Learning. All rights reserved. 115 Burns Burns require two codes –One for site and degree –Second for percentage of body surface

116. Copyright © 2008 Delmar Learning. All rights reserved. 116 ICD-10: Coding for the Future By 2010? –Tenth revision of the International Classification of Diseases is expected to replace the ICD-9

117. Copyright © 2008 Delmar Learning. All rights reserved. 117 ICD-10: Coding for the Future ICD-10-CM –Includes more codes and is designed to collect more data on every type of health care encounter

118. Copyright © 2008 Delmar Learning. All rights reserved. 118 ICD-10: Coding for the Future History of the ICD coding –ICD coding serves as a statistical tool for international collection and exchange of mortality (death) data

119. Copyright © 2008 Delmar Learning. All rights reserved. 119 ICD-10: Coding for the Future ICD-10 is being modified to: –Return to or exceed the level of specificity found in ICD-9-CM Expand alphabetic Index to Diseases

120. Copyright © 2008 Delmar Learning. All rights reserved. 120 ICD-10: Coding for the Future Provide code titles and language that complement accepted clinical practice Remove codes unique to mortality coding

121. Copyright © 2008 Delmar Learning. All rights reserved. 121 ICD-10: Coding for the Future Modifications applied by the NCHS include: –Increasing ICD-10’s five character structure to six characters

122. Copyright © 2008 Delmar Learning. All rights reserved. 122 ICD-10: Coding for the Future Incorporating common fourth-digit subcategories and fifth-digit sub classifications Adding trimesters to obstetric codes

123. Copyright © 2008 Delmar Learning. All rights reserved. 123 ICD-10: Coding for the Future Creating codes that allow for laterality –Unique code for right arm Creating combined diagnostic/symptoms codes

124. Copyright © 2008 Delmar Learning. All rights reserved. 124 ICD-10 Volumes ICD-10 published three volumes: –Volume 1-1992 –Volume 2-1993 –Volume 3-1994 Volume 1 contains a tabular list of alphabetic disease codes

125. Copyright © 2008 Delmar Learning. All rights reserved. 125 ICD-10 Volumes ICD 10 Volume 2: Instruction Manual –Volume 2 of ICD-10 Contains rules and guidelines for mortality and morbidity coding –ICD 10-CM Undecided whether a separate volume will be dedicated to rules, or be organized under a different volume

126. Copyright © 2008 Delmar Learning. All rights reserved. 126 ICD-10 Volumes ICD-10 volume 3: Alphabetic Index –Volume 3 of ICD-10 is an index to codes classified in the Tabular List

127. Copyright © 2008 Delmar Learning. All rights reserved. 127 Organizational Changes in ICD-10 and ICD-10-CM ICD-10-CM will seem familiar –But some classification changes include iatrogenic illness, sequelae, and injury Iatrogenic illness results from medical intervention

128. Copyright © 2008 Delmar Learning. All rights reserved. 128 Organizational Changes in ICD-10 and ICD-10-CM Sequelae –Late effects from injury or illness

129. Copyright © 2008 Delmar Learning. All rights reserved. 129 Organizational Changes in ICD-10 and ICD-10-CM In ICD-10 codes appear at the end of each anatomic chapter –Injury is a wound or some other damage to an organ

130. Copyright © 2008 Delmar Learning. All rights reserved. 130 Organizational Changes in ICD-10 and ICD-10-CM In ICD-10-CM injuries to the head are subdivided into the following three-digit categories: –S00 Superficial injury of head –S01 Open wound of head

131. Copyright © 2008 Delmar Learning. All rights reserved. 131 Organizational Changes in ICD-10 and ICD-10-CM S02 –Fracture of skull and facial bones S03 –Dislocation, sprain, and strain of joints and ligaments of head S04 –Injury of cranial nerves

132. Copyright © 2008 Delmar Learning. All rights reserved. 132 Organizational Changes in ICD-10 and ICD-10-CM S05 –Injury of eye and orbit S06 –Intracranial injury S07 –Crushing head injury

133. Copyright © 2008 Delmar Learning. All rights reserved. 133 Organizational Changes in ICD-10 and ICD-10-CM S08 –Traumatic amputation of part of head S09 –Other and underspecified injuries of head

134. Copyright © 2008 Delmar Learning. All rights reserved. 134 Important Issues When Comparing ICD-10 and ICD-9 E codes in the ICD 10 –Classify diseases of endocrine system, not external causes In ICD 9, external cause is currently classified as E codes –However, in ICD-10-CM they will be V codes

135. Copyright © 2008 Delmar Learning. All rights reserved. 135 Important Issues When Comparing ICD-10 and ICD-9 V codes in the ICD-9-CM supplemental classification to report factors related to health status –Changed in ICD-10-CM to U and Z codes

136. Copyright © 2008 Delmar Learning. All rights reserved. 136 Important Issues When Comparing ICD-10 and ICD-9 J codes in the HCPCS Level II report drug administration In the ICD-10-CM –J codes report disorder of the respiratory system

137. Copyright © 2008 Delmar Learning. All rights reserved. 137 Implementing ICD-10-CM Create a task force –Create implementation ICD-10-CM responsibilities into work topics and assign each member a job.

138. Copyright © 2008 Delmar Learning. All rights reserved. 138 Implementing ICD-10-CM Be vigilant –Assign one member to research articles about ICD-9-CM implementation found in newsletters, the internet, and the Federal Register.

139. Copyright © 2008 Delmar Learning. All rights reserved. 139 Implementing ICD-10-CM Alert organization change to ICD-10-CM –Transition to ICD-10-CM affects all departments –Open task force meetings to entire organization Invite representatives to become part of the working group

140. Copyright © 2008 Delmar Learning. All rights reserved. 140 Implementing ICD-10-CM Anticipate problems –Plan for education and training of personal –Involve computer information systems in the transition to ICD-10-CM

141. Copyright © 2008 Delmar Learning. All rights reserved. 141 Implementing ICD-10-CM Train physicians –Required detail in ICD-10-CM emphasizes physician participation –Patient chart must specify terminology and complete documentation

142. Copyright © 2008 Delmar Learning. All rights reserved. 142 Implementing ICD-10-CM Review patients’ charts: –Identify documentation problems relevant to ICD-10-CM

143. Copyright © 2008 Delmar Learning. All rights reserved. 143 Implementing ICD-10-CM The United States adopted the ICD-9-CM to facilitate the coding and classification of morbidity disease data from inpatient, outpatient, physician records, and statistical surveys.