DC: Ch. 3 Conventions & Steps in Coding

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Understanding ICD-9-CM Coding A Worktext mary Jo bowie Regina Schaffer


Used to connect a series of terms apprearing on the left of the brace to a common term on the right of the brace. The words on the left must be followed by the words on the right to be included in the code number being considered.

Code First Underlying Disease, Cause or Condition

pg. 47

A type of instructional notation that appears in the Tabular List and must always be followed because it instructs the coder to use an additional code to identify an underlying disease, cause or condition that is present. Therefore two codes are needed to fully code the diagnostic statement. The two codes must appear in the order stated.



Used in the Tabular Index atfer a term that is modified by one or more of the terms following the colon. The term to the left of the colon must be modified by a term on the right to be included in the code being considered.


A group of instructional notations, punctuation marks, abbreviations and symbols.


A type of instructional notation used to signify that the conditions listed are not assigned to the chapter, section, category, or fourth-or fifth-digit code listed.

Exclusion Note

Another reference for "Excludes:"


A type of instructional notation (also called an inclusion note) used to define and give examples of the content of a chapter, section, category, or subcategory code.

Placement effects what codes the note applies to:
Chapter Level = the entire chapter
Section Level = the entire section
Category Code Level = the category range
Fourth or Fifth Digit Levels = the term "Includes:" does not actually appear at these levels, but it is assumed.

Inclusion Note:

Another reference for "Includes:"

Instructional Notations

Phrases or notes that appear in all three volumes of the code book and provide information related to code selection.

Italicized Brackets

Used in the Alphabetic Index to enclose a second code that must be assigned when coding. This is used to record the etiology and/or manifestation of a disease. Report these codes in the order they appear in the index.

Not elsewhere Classifiable (NEC)

pg. 51

There are two purposes for NEC. (1) Used with poorly defined terms to warn the coder that specified forms of the diagnosis being coded are classified to different code numbers. (2) Use when the Tabular List does not provide a separate code for the diagnosis being coded even though the diagnosis was very specific.Use this code only as a last resort when more precise codes are not available.

Not Otherwise Specified (NOS)

p. 51

Used in the Tabular List to indicate the diagnosis is unspecified. In this case the coder should consult the doctor and/or medical record to see if a more specific diagnosis is available.


Used around terms that provide additional information about the main diagnostic term. These are called nonessential modifiers because the do not affect the code assignment. Used in both the Tabular List and Alphabetical Index.


A type of instructional notation used in the Alphabetic Index of ICD-9-CM that instructs the coder to cross-reference the term or diagnosis that follows the notation.

See Also:

A type of instructional notation refers the coder to another location in the Alphabetic Index when the initial listing does not contain all the necessary information to select a code accurately.

See Category:

A type of instructional notation used in the Alphabetic Index of ICD-9-CM that instructs the coder to cross-reference a specific category in the Tabular List.

Slanted Brackets


Square Brackets

These enclose synonyms,alternative wording, abbreviations, or explanatory phrases. The presence or absence of the bracketed phrase does not affect code assignment. Used in the Tabular List only.

Use Additional Code

pg. 48

An instructional notation that signals the coder to add a second code to fully code the diagnosis.

Section Mark Symbol
(looks like two Ss on top of each other)

p. 52

This symbol denotes the presence of a footnote that the coder should reference.

Coding Steps

1. Locate the main term in the Alphabetic Index (starting on page 51.)

2. Scan the main term entry for any instructional notations.

3. In the diagnostic phrase being coded. Identify any terms that modify the mail term.

4. Follow any cross-reference notations.

5. Always verify the code in the Tabular List of Diseases and Injuries.

6. Follow any instructional terms by checking all the following in order:
1) Start of the chapter (ex: Diseases of the Respiratory System)
2) Start of the section range (ex: 470-478)
3) Beginning of the category, subcategory, or subclassification level

7. Select the code.

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