1. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 6 CHAPTER-SPECIFIC GUIDELINES (ICD-9-CM CHAPTERS 9-17)

2. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2 Chapter 9 Diseases of Digestive SystemDiseases of Digestive System –Mouth to anus and accessory organs –Extensive subcategories 574 Cholelithiasis (10 subcategories)574 Cholelithiasis (10 subcategories) Each has fifth digit subclassificationEach has fifth digit subclassification –Presence of hemorrhage associated with diseases in this chapter Query provider if documentation is not clearQuery provider if documentation is not clear

3. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3 Chapter 10 Diseases of Genitourinary SystemDiseases of Genitourinary System Commonly used codesCommonly used codes –Urinary tract infection (599.0) –Inflammation of prostate (601.X) –Disorders of menstruation (626-627) & breast (610-612) Use additional code to identify organism Use additional codes to identify lower urinary tract symptomUse additional code to identify organism Use additional codes to identify lower urinary tract symptom

4. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4 Chapter 11, Complications of Pregnancy, Childbirth, and the Puerperium Extensive multiple coding with many fifth digit assignments and notesExtensive multiple coding with many fifth digit assignments and notes Chapter 11 codes take precedence over codes from other chaptersChapter 11 codes take precedence over codes from other chapters Admission for pregnancy, complicationAdmission for pregnancy, complication –Obstetric complication = first-listed diagnosis

5. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5 Section I.C.11. Complications of Pregnancy, Childbirth, and Puerperium Chapter 11 codesChapter 11 codes Mother’s medical record (600 series codes)Mother’s medical record (600 series codes) Not on newborn medical record (Newborn, 700 series codes)Not on newborn medical record (Newborn, 700 series codes) (Cont’d…)

6. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6 Section I.C.11. Complications of Pregnancy, Childbirth, and Puerperium (…Cont’d) Mother’s recordMother’s record –Outcome of delivery code (V27.0-V27.9) when delivered

7. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7 Section I.C.11.a. General Rules for Obstetric Cases Not all encounters are pregnancy relatedNot all encounters are pregnancy related –Example, pregnant woman, broken ankle Broken ankleBroken ankle V22.2 Pregnant state incidental must be documented in medical record treated condition not affecting pregnancyV22.2 Pregnant state incidental must be documented in medical record treated condition not affecting pregnancy

8. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8 Section I.C.11.a.4. Fifth Digit All categories EXCEPT 650 (Normal delivery)All categories EXCEPT 650 (Normal delivery) Requires fifth digit for:Requires fifth digit for: –Antepartum –Postpartum –Delivery

9. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9 Codes 640-676.9 Share Fifth-Digit Subclassification Denotes current episode of careDenotes current episode of care –0 Unspecified as to episode of care or not applicable –1 Delivered, with or without mention of antepartum condition –2 Delivered, with mention of postpartum complication –3 Antepartum condition or complication –4 Postpartum condition or complication

10. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10 Section I.C.11.b. Selection of Principal Diagnosis—Obstetric No delivery: Principal diagnosis = principal complicationNo delivery: Principal diagnosis = principal complication >1 complication, sequence any first>1 complication, sequence any first (Cont’d…)

11. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11 Section I.C.11.b. Selection of Primary Diagnosis (…Cont’d) Routine prenatal visits no complications:Routine prenatal visits no complications: –V22.0, Supervision, normal first pregnancy or –V22.1, Supervision, other normal pregnancy –Always primary diagnosis Prenatal outpatient visits for high-risk pregnancies:Prenatal outpatient visits for high-risk pregnancies: –V23, Supervision of high-risk pregnancy (V23.X)

12. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12 Section I.C.11.c.1. Fetal Conditions Affect Mother Codes from Categories 655 and 656Codes from Categories 655 and 656 Assign only if known or suspected fetal abnormality affects management of the motherAssign only if known or suspected fetal abnormality affects management of the mother Requires additional diagnostic studies, observation, special care or termination of the pregnancyRequires additional diagnostic studies, observation, special care or termination of the pregnancy The existence of a fetal condition alone does not justify reporting these codesThe existence of a fetal condition alone does not justify reporting these codes

13. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13 Section I.C.11.c.2. In Utero Surgery When surgery is performed on the fetus, report a code from Category 655 identifying the fetal conditionWhen surgery is performed on the fetus, report a code from Category 655 identifying the fetal condition No code from Chapter 15, perinatal codes, should be used on the mother’s record to identify fetal conditionsNo code from Chapter 15, perinatal codes, should be used on the mother’s record to identify fetal conditions Surgery performed in utero on the fetus is still coded as an obstetric encounterSurgery performed in utero on the fetus is still coded as an obstetric encounter

14. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14 Section I.C.11.d. HIV Infection in Pregnancy, Childbirth, Puerperium Patient admitted during this period because of an HIV-related illness should receivePatient admitted during this period because of an HIV-related illness should receive –a principal code of 647.6x –followed by 042 Patient admitted with asymptomatic HIV status should be reportedPatient admitted with asymptomatic HIV status should be reported –647.6x –V08

15. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 15 Section I.C.11.e. Current Conditions Complicating Pregnancy Assign a code from Category 648.x for patient with current condition that affects management of the pregnancy, childbirth or the puerperiumAssign a code from Category 648.x for patient with current condition that affects management of the pregnancy, childbirth or the puerperium Use additional secondary code from other chapters to identify conditionsUse additional secondary code from other chapters to identify conditions

16. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 16 Section I.C.11.f. Diabetes Mellitus in Pregnancy Significant complicating factor in pregnancySignificant complicating factor in pregnancy Diabetic pregnant patients should be assigned code 648.0x ANDDiabetic pregnant patients should be assigned code 648.0x AND A secondary code from Category 250 to identify type of diabetesA secondary code from Category 250 to identify type of diabetes Code V58.67, Long-term (current) use of insulin should also be reported if appropriateCode V58.67, Long-term (current) use of insulin should also be reported if appropriate

17. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 17 Section I.C.11.g. Gestational Diabetes Occurs in second and third trimester in women who were not diabetic prior to pregnancyOccurs in second and third trimester in women who were not diabetic prior to pregnancy Can cause complications in pregnancy similar to those of pre-existing diabetesCan cause complications in pregnancy similar to those of pre-existing diabetes Puts women at greater risk of developing diabetes after the pregnancyPuts women at greater risk of developing diabetes after the pregnancy (Cont’d…)

18. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 18 Section I.C.11.g. Gestational Diabetes (…Cont’d) Report 648.8xReport 648.8x NEVER report codes 648.0x and 648.8x togetherNEVER report codes 648.0x and 648.8x together Code V58.67, Long-term (current) use of insulin should also be reported if gestational diabetes is being treated with insulinCode V58.67, Long-term (current) use of insulin should also be reported if gestational diabetes is being treated with insulin

19. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 19 Section I.C.11.h. Normal Delivery, 650 No complications, principal diagnosis = 650No complications, principal diagnosis = 650 With complications = NOT 650With complications = NOT 650 V27.0 ( Single liveborn)V27.0 ( Single liveborn) –Only outcome for 650 (Normal Delivery) Normal delivery with resolved antepartum condition = 650Normal delivery with resolved antepartum condition = 650

20. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 20 Section I.C.11.i.1. Postpartum and Peripartum Periods After delivery and continues for 6 weeksAfter delivery and continues for 6 weeks Peripartum periodPeripartum period –Last month of pregnancy to five months postpartum

21. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 21 Section I.C.11.i.2,3,4 Postpartum Complications Any complication occurring within the 6-week periodAny complication occurring within the 6-week period Complications occurring after the 6-week period may be reported with Chapter 11 codes, if the provider documents they are pregnancy relatedComplications occurring after the 6-week period may be reported with Chapter 11 codes, if the provider documents they are pregnancy related Complications occurring during the same admission as delivery are reported with fifth digit “2”; subsequent admissions/encounters with fifth digit “4”Complications occurring during the same admission as delivery are reported with fifth digit “2”; subsequent admissions/encounters with fifth digit “4”

22. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 22 Section I.C.11.i.5 Care following delivery outside hospital If delivered prior to admissionIf delivered prior to admission –In ambulance –At home –In ED DO NOT CODE deliveryDO NOT CODE delivery Code any postpartum careCode any postpartum care

23. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 23 Section I.C.11.j. Late Effect of Complication of Pregnancy Category 677Category 677 Reported when an initial complication of pregnancy requires care or treatment at a future dateReported when an initial complication of pregnancy requires care or treatment at a future date Category reported any time after initial postpartum periodCategory reported any time after initial postpartum period Like all late effects, code is sequenced following the complicating condition codeLike all late effects, code is sequenced following the complicating condition code

24. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 24 Section I.C.11.k. Abortions Codes 634-637 require fifth digits:Codes 634-637 require fifth digits: –0: Unspecified –1: Incomplete (POC, product of conception) NOT expelled –2: Complete, all (POC) expelled prior to care

25. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 25 Section I.C.11.k.1. Fifth Digit Appropriate fifth digit listed under each codeAppropriate fifth digit listed under each code 640.0, Threatened abortion640.0, Threatened abortion –0: Unspecified episode –1: Delivered with or without complication –3: Antepartum condition or complication Note that NOT all fifth digits are applicable (2 and 4)Note that NOT all fifth digits are applicable (2 and 4)

26. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 26 Section I.C.11.k.4. Abortion with Liveborn Fetus Attempted abortion results in liveborn fetus:Attempted abortion results in liveborn fetus: –644.21 (Early onset of delivery) appropriately Use V27 (Outcome of delivery)Use V27 (Outcome of delivery) Attempted abortion procedure code also assignedAttempted abortion procedure code also assigned

27. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 27 Section I.C.11.k.5. Retained Products of Conception Subsequent admissions for retained products of conception following a spontaneous or legally induced abortion are reported with code from:Subsequent admissions for retained products of conception following a spontaneous or legally induced abortion are reported with code from: –634 Spontaneous abortion –635 Legally induced abortion –With fifth digit “1” (incomplete) –Appropriate even if patient previously discharged with diagnosis of “complete”

28. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 28 Chapter 12, Diseases of Skin and Subcutaneous Tissue SKIN EpidermisEpidermis DermisDermis Subcutaneous tissueSubcutaneous tissue Infectious Skin/Subcutaneous TissueInfectious Skin/Subcutaneous Tissue Scar tissueScar tissue ACCESSORY ORGANS Sweat glandsSweat glands Sebaceous glandsSebaceous glands NailsNails Hair and hair folliclesHair and hair follicles OtherOther (Cont’d…)

29. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 29 Chapter 12 (…Cont’d) Multiple codes often necessaryMultiple codes often necessary –Example: Cellulitis due to Staph –Cellulitis 682.9 –Staph 041.1X

30. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 30 Chapter 13, Diseases of Musculoskeletal System and Connective Tissue BoneBone BursaBursa CartilageCartilage FasciaFascia LigamentsLigaments MuscleMuscle SynoviaSynovia TendonsTendons

31. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 31 Chapter 13 Sections Arthropathies (joint disease) and Related DisordersArthropathies (joint disease) and Related Disorders Dorsopathies (curvature of spine)Dorsopathies (curvature of spine) Rheumatism, Excluding backRheumatism, Excluding back Osteopathies, Chondropathies, and Acquired Musculoskeletal DeformitiesOsteopathies, Chondropathies, and Acquired Musculoskeletal Deformities Newly Diagnosed Pathologic FracturesNewly Diagnosed Pathologic Fractures Extensive notes and fifth digitsExtensive notes and fifth digits

32. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 32 Chapter 13, Diseases of Musculoskeletal System and Connective Tissue Refer to the note at the beginning of the chapter regarding fifth-digit sub- classificationsRefer to the note at the beginning of the chapter regarding fifth-digit sub- classifications Details located there are not repeated in the categoriesDetails located there are not repeated in the categories Used for Categories 711-712, 715-716, 718-719, and 730Used for Categories 711-712, 715-716, 718-719, and 730

33. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 33 Chapters 14 and 15 Congenital Anomalies (abnormality at birth) (740-759)Congenital Anomalies (abnormality at birth) (740-759) Conditions Originating in Perinatal PeriodConditions Originating in Perinatal Period –Perinatal period through 28th day following birth –Codes can be used after 28 th day if documented that condition originated during perinatal period

34. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 34 Section I.C.15.b. Use of Codes V30-V39 V30-V39 liveborn infant(s)V30-V39 liveborn infant(s) Example:Example: –V30, Single liveborn –V31, Liveborn twins Inpatient: Principal diagnosisInpatient: Principal diagnosis Note: V30 ONLY used once, hospital where baby deliveredNote: V30 ONLY used once, hospital where baby delivered

35. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 35 Section I.C.15.d. Use of Category V29 Assign code when healthy newborn/infant is evaluated for suspected condition not foundAssign code when healthy newborn/infant is evaluated for suspected condition not found Do not use when patient has signs/symptoms of a suspected problem, code the signs/symptomsDo not use when patient has signs/symptoms of a suspected problem, code the signs/symptoms V29 is used secondary to V30V29 is used secondary to V30

36. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 36 Section I.C.15.f. Maternal Causes of Perinatal Morbidity Codes from Categories 760-763 are assigned only when the maternal condition actually affected the fetus/newbornCodes from Categories 760-763 are assigned only when the maternal condition actually affected the fetus/newborn The fact that the mother has a medical condition or experiences a complication does not justify routine reporting of these categoriesThe fact that the mother has a medical condition or experiences a complication does not justify routine reporting of these categories

37. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 37 Section I.C.15.h. Coding Additional Perinatal Diagnoses Code newborn conditions that require:Code newborn conditions that require: –Treatment –Further investigation –Additional resource –Prolonged length of stay (LOS) –Implications for future care (Cont’d…)

38. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 38 Section I.C.15.h. Coding Additional Perinatal Diagnoses (…Cont’d) Insignificant newborn conditions, signs, symptomsInsignificant newborn conditions, signs, symptoms –Resolve with no treatment –Need no code EVEN IF documentedEVEN IF documented

39. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 39 Section I.C.15.i. Prematurity and Fetal Growth Retardation Codes for newborns from categoriesCodes for newborns from categories –764 (Slow fetal growth and fetal malnutrition) and –765 (Disorders relating to short gestation and low birthweight) (Cont’d…)

40. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 40 Section I.C.15.i. Prematurity and Fetal Growth Retardation (…Cont’d) Not assigned solely on birthweight or gestational age of newbornNot assigned solely on birthweight or gestational age of newborn –Use clinical assessment instead Use physician’s assessment of maturityUse physician’s assessment of maturity Use additional code for number of weeks of gestation (765.0 and 765.1)Use additional code for number of weeks of gestation (765.0 and 765.1)

41. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 41 Section I.C.15.j. Newborn Sepsis Code 771.81 should be assigned a secondary code from category 041 to identify the organismCode 771.81 should be assigned a secondary code from category 041 to identify the organism Do not report category 038Do not report category 038 Do not assign 995.91, Sepsis, assign 771.81Do not assign 995.91, Sepsis, assign 771.81

42. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 42 Chapter 16, Symptoms, Signs, and Ill-Defined Conditions Do NOT code a sign or symptom if:Do NOT code a sign or symptom if: –Definitive diagnosis made (symptoms are part of disease) Only used if no specific diagnosis statedOnly used if no specific diagnosis stated Signs/symptoms are transient or cause not determinedSigns/symptoms are transient or cause not determined Patient fails to return and provisional diagnosis is all that is documentedPatient fails to return and provisional diagnosis is all that is documented (Cont’d …)

43. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 43 Chapter 16, Symptoms, Signs, and Ill-Defined Conditions (…Cont’d) More precise diagnosis not available for any other reasonMore precise diagnosis not available for any other reason Certain symptoms that may represent important problems in medical care exist and might be desirable to classify them in addition to the known causeCertain symptoms that may represent important problems in medical care exist and might be desirable to classify them in addition to the known cause

44. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 44 Chapter 17 Injury and Poisoning, Section Examples FracturesFractures DislocationsDislocations Sprains and StrainsSprains and Strains Intracranial InjuryIntracranial Injury Internal InjuryInternal Injury Crushing InjuryCrushing Injury Foreign BodyForeign Body BurnsBurns Late EffectsLate Effects PoisoningPoisoning

45. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 45 Section I.C.17.c. Burns Sequence highest degree burn firstSequence highest degree burn first Current burns (940-948) classified byCurrent burns (940-948) classified by –Depth (severity) –Extent (% body surface) –Site –And if necessary, agent (Cont’d …)

46. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 46 Section I.C.17.c. Burns (…Cont’d) Depth of burn is classified asDepth of burn is classified as –First degree: Erythema –Second degree: Blistering –Third degree: Full-thickness involvement

47. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 47 Section I.C.17.c. Burns Classified According to extent body surface involvedAccording to extent body surface involved Burn site NOT specifiedBurn site NOT specified –Additional data required Burns of different degrees/same local siteBurns of different degrees/same local site –Report highest degree only Non-healing burns are reported as acute burnsNon-healing burns are reported as acute burns Report 958.3 as additional code for infected burn siteReport 958.3 as additional code for infected burn site

48. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 48 Section I.C.17.c.6. Category 948 Fourth digits = % total body surface involvedFourth digits = % total body surface involved Fifth digits = % body surface involved in third-degree burnsFifth digits = % body surface involved in third-degree burns Rule of Nines appliesRule of Nines applies (Cont’d…)

49. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 49 (…Cont’d) Rule of Nines Figure: 6.6

50. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 50 Section I.C.17.d. Debridement of Wounds, Infection, or Burn Excisional debridement (86.22)Excisional debridement (86.22) –Cut away –Performed by physician Nonexcisional procedure (86.28)Nonexcisional procedure (86.28) –Shaved or scraped (includes water scalpel [jet]) –Performed by physician or –Nonphysician

51. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 51 Section I.C.17. Injury and Poisoning (800-999) Separate code for each injurySeparate code for each injury Most serious injury firstMost serious injury first Superficial injuries not reported if in same location as more serious injurySuperficial injuries not reported if in same location as more serious injury WoundsWounds –Without mention of complication –Complicated Documented delayed healing/treatment, foreign body, primary infectionDocumented delayed healing/treatment, foreign body, primary infection –With tendon involvement

52. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 52 Section I.C.17.a.2. Vessel and Nerve Damage Code primary injury firstCode primary injury first –Use additional code if nerve/vessel damage minor Primary injury = nerve/vessel damagePrimary injury = nerve/vessel damage Code nerve/vessel damage firstCode nerve/vessel damage first

53. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 53 Section 1.C.17.b.1. Acute Fracture vs. Aftercare Active treatment of fracture (800-829) may be:Active treatment of fracture (800-829) may be: –Physician evaluation –ER encounter –Surgical treatment –Closed treatment After active treatment completed, use aftercare codesAfter active treatment completed, use aftercare codes –Aftercare involving internal fixation (V54.X) –Aftercare for healing traumatic fracture (V54.1X) –Other orthopedic aftercare (V54.8X) –Unspecified orthopedic aftercare (V54.9)

54. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 54 Section I.C.17.b.2. Multiple Fractures Same coding principles as multiple injuriesSame coding principles as multiple injuries Code multiple fractures, by siteCode multiple fractures, by site Sequenced by severitySequenced by severity Codes describe accidents, injury, open wounds, etc.Codes describe accidents, injury, open wounds, etc. (Cont’d …)

55. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 55 Fractures (…Cont’d) Not indicated as closed or open = closedNot indicated as closed or open = closed Same bone fractured AND dislocatedSame bone fractured AND dislocated –Code fracture ONLY (highest level of injury)

56. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 56 Section I.C.17.e. Adverse Effects, Poisoning, and Toxic Effects Properties of some drugs, medicinal, and biological substances, or combinations may cause toxic reactionsProperties of some drugs, medicinal, and biological substances, or combinations may cause toxic reactions Classify as Adverse Effect when drug was correctly prescribed/administeredClassify as Adverse Effect when drug was correctly prescribed/administered –Code effect first –E-code from therapeutic column for drug

57. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 57 Section I.C.17.e. Adverse Effects, Poisoning, and Toxic Effects Poisoning occurs when drugs/chemical substances are not taken as directed Wrong dosage given in errorWrong dosage given in error Medication given to wrong personMedication given to wrong person Medication taken by wrong personMedication taken by wrong person Medication overdose has occurredMedication overdose has occurred Medications (prescription or over-the-counter) taken in combination with alcohol and/or recreational drugsMedications (prescription or over-the-counter) taken in combination with alcohol and/or recreational drugs Over-the-counter taken in combination with prescription drugs without provider approvalOver-the-counter taken in combination with prescription drugs without provider approval

58. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 58 Section I.C.17.e. Adverse Effects, Poisoning, and Toxic Effects Sequencing of Poisoning: Poisoning code from Table of Drugs & Chemicals firstPoisoning code from Table of Drugs & Chemicals first Manifestation(s) of the poisoning secondManifestation(s) of the poisoning second Corresponding E-code from the Table of Drugs and Chemicals lastCorresponding E-code from the Table of Drugs and Chemicals last –If intent unknown or questionable, report intent as undetermined (E980-E989)

59. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 59 E Codes Provides supplemental informationProvides supplemental information Never first-listed diagnosisNever first-listed diagnosis Identify:Identify: –Cause of an injury or poisoning, –Intent (unintentional or intentional), and –Place it occurred

60. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 60 General E Code Guidelines Use with any code in Vol. 1Use with any code in Vol. 1 Initial encounterInitial encounter –Use E code Subsequent encounterSubsequent encounter –Use late effects E CODES

61. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 61 Intent Intent UnknownUnknown UnspecifiedUnspecified QuestionableQuestionable Code As Undetermined*Undetermined* *(E980-E989)

62. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 62 Section I.C.19.c. Table of Drugs and Chemicals Alphabetic listing with codesAlphabetic listing with codes Do NOT code directly from TableDo NOT code directly from Table Always reference TabularAlways reference Tabular

63. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 63 Section I.C.19.c. Two or More Substances Involved If two or more substances involved code:If two or more substances involved code: –Each unless combination code exists Code substance more closely related to principal diagnosis, andCode substance more closely related to principal diagnosis, and –Include one code from each category (cause, intent, place) Interaction of a drug(s) and alcoholInteraction of a drug(s) and alcohol –Using poisoning and E codes for both

64. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 64 Section I.C.19.e. Unknown or Suspected Intent UnknownUnknown UnspecifiedUnspecified QuestionableQuestionable UndeterminedE980-E989

65. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 65 Section I.C.19.f. Undetermined Cause Intent known, cause unknown, useIntent known, cause unknown, use –E928.9, Unspecified accident –E958.9, Suicide and self-inflicted injury by unspecified means –E968.9, Assault by unspecified means

66. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 66 Section I.C.19.g. Late Effects of External Cause Should be used with late effect of a previous injury/poisoningShould be used with late effect of a previous injury/poisoning Should NOT be used with related current injury codeShould NOT be used with related current injury code

67. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 67 Conclusion CHAPTER 6 CHAPTER-SPECIFIC GUIDELINES (ICD-9-CM CHAPTERS 9-17)