1. Coding Update 2006 Primary Care Conference March 29, 2006

2. ICD-9-CM International Classification of Diseases - 9 th Edition - Clinical Modification ICD-10 already in use internationally –2009 for USA ??

3. ICD-9-CM Coding Guidelines National Center for Health Statistics website http://www.cdc.gov/nchs/icd9.htm Coding Clinic – issued quarterly by American Hospital Association

4. Diagnosis Code Tips Do not code diagnoses documented as rule out (R/O), probable, suspected, or consistent with…

5. Abnormal findings Findings, abnormal, w/o diagnosis –Positive PPD –Prolonged bleeding time –Electrocardiogram –Liver function tests

6. Signs & Symptoms Fever Dysuria Wheezing Fatigue Knee pain

7. ICD arranged by Condition Bronchitis Pain Sprain Bursitis Cellulitis

8. Site or Type Pain, –ankle –knee Arthritis –inflammatory –fingers –multiple sites

9. Malignancy coding Locate code by histological type; (eg melanoma, astrocytoma) Code as malignancy as long as it is still being treated Code as a history of malignancy once active treatment has ended

10. Neoplasms Neoplasm Table –Primary –Secondary –Ca in situ –Benign –Uncertain Behavior –Unspecified

11. Unknown primary malignancy Assign code 199.1 for unknown primary, if still actively treated

12. Diabetes – compound coding If using a fourth digit to describe complication – code also the complication as a secondary code

13. Diabetes Mellitus – 4 th digits 250.0x = w/o mention of complication 250.1x = w/ketoacidosis 250.2x = w/hyperosmolarity 250.3x = w/other coma 250.4x = w/renal manifestations

14. Diabetes Mellitus – 4 th digit 250.5x = w/ophthalmic manifestations 250.6x = w/neurologic manifestations 250.7x = w/peripheral circulatory disorders 250.8x = w/other specified manifestations 250.9x = w/unspecified complications

15. Diabetes – 5 th digit 0type II or unspecified, not uncontrolled 1type I, not uncontrolled 2 type II or unspecified, uncontrolled 3type I, uncontrolled

16. Nursing Facility Codes Skilled Nursing (SNF) Intermediate Care (ICF) Long Term Care (LTCF) Psychiatric Residential Treatment Center

17. Nursing Facility Services Three levels of service for admissions Four levels for subsequent care Comprehensive annual assessment

18. Domiciliary, Rest Home or Custodial Care services Section revised to better capture care provided in these settings Increasing number of patients with complex diseases (eg, Alzheimer patients)