Chapter 6 ICD-9 Part 1

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The International Classification of Diseases (ICD) is used to code and classify

mortality(death) data from deth certificates

The IcD 9 Cm is used to code and classify

morbidity(disease) data from impatient and outpatient records

The health insurance specialist employed in a physcianc's office assigns ICD-9-Cm codes to

diagnoses, signs, and symptoms documented by the healthcare provider

The ICD-9-CM is organized into

three volumes

Volume 1 of the ICD-9-Cm is

tabular list of Diseases

Volume 2 of the ICD-9-Cm is

Index to diseases

Volume 3 of the ICD-9-Cm is

index to procedures and Tabular list of procedures usually used in a hospital

Mandatory reporting of Icd-9-cm codes

The medicare act of 1988 mandated the reporting of ICD-9-Cm diagnoses codes on Medicare claims

Requiring diagnosis codes to be reported on submitted claims establishes the
(Mandatory reporting of Icd-9-cm codes)

medical necessity of procedures and services rendered to patients

Medical necessity is defined as
(Mandatory reporting of Icd-9-cm codes)

the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury

By medicare, the patient must sign an
(Mandatory reporting of Icd-9-cm codes)

advance beneficiary notice (abn) which acknowledges patient responsibility

ICD-9-Cm Anaual Updates

Cms enforces regulations pursuant to the Medicare Prescription Drug improvement and Moderization Act (MMA) which require that all code sets reported on claims be valid at the time services are provided

To be compliant, this means that traditonal mid-year and end-of-year coding updates
(ICD-9-Cm Anaual Updates)

must be immediatley implented so that accurate codes are reported on submitted claims

If outdated codes are submitted on claims, providers, and healthcare facilities will incur
(ICD-9-Cm Anaual Updates)

administrative cost associated with resubmitting administrative costs associated with resubmitting corrected claims and delayed reimbursment for services provided

ICd-10-Cm/PCS will replace

Icd-9-cm on OCt. 1st 2013

Icd-10-cms/pcs includes many

more codes and applies to more users

ICD-10-Cm/PCS also enhances

accurate payment for services rendered

The Diagnostic coding and reporting guidelines for outpatient services: Hospital based and Physician office were
(Outpatinet Coding Guidelines)

developed by the federal government for use in reporting diagnoses for claims submission

Four cooperating parties are involved in the continued development and approval of these guidlines
(Outpatinet Coding Guidelines)

American hospital association, american health information Management association, Centers for Medicare and Medicaid services, National center for Health Statistics

1) American Hospital Assciation
(Outpatinet Coding Guidelines)

AHA

2) American Health Information Managment Association
(Outpatinet Coding Guidelines)

AHIMA

3)Centers for medicare and medicaid services
(Outpatinet Coding Guidelines)

Cms, formerly HCFA

4) NAtional Center for Health Statistics
(Outpatinet Coding Guidelines)

NCHS

Coding Tip

begin the search for the correct code by referring to the index to diseases. never beign searching for a code int he tabular list of diseases because this will lead to coding errors

In the outpatient setting, the term first-listed diagnosis is used and it is determined in accordance with
(A. Selection of first-listed Condition)

Icd-9-cm's coding conventions as well as general and disease specific coding guidelines

An outpatient is a person treated in one of four settings
(A. Selection of first-listed Condition)

Ambulatory surgery center, healthcare providers office, hospital clinic, emergency dept. outpaitnet dept., hospital observation

Ambulatory surgery center
(A. Selection of first-listed Condition)

where the patient is released prior to a 24-hr stay

hospital clinic, emergency dept., outpaitnet dept.,
(A. Selection of first-listed Condition)

same-day surgery unit

hospital observation
(A. Selection of first-listed Condition)

where the patients length of stay is 23hrs , 59 mins and 59 secs or less

An impatient is a person admitted to a hospital or long term care facility for treatment
(A. Selection of first-listed Condition)

with the expectation that the patient will remain in the hospital for a period of 24 hrs. or more

You may see prncipal diagnses refereed to as first-listed diagnosis in medical literature. Remeber..
(A. Selection of first-listed Condition)

the outpatinet settings first listed diagnosis is not the principal diagnosis

The inpatint principal diagnosis is defined as
(A. Selection of first-listed Condition)

the condition determined after study which resulted in the patient's admission to the hospital

Codes 001.0-v89.09 must be used to identify
(B. Icd 9 cm tabular list of diseases (codes 001.0 -v89.09)

diagnoses, conditions, problems, complaint or any other reason for the encounter/visit

Codes 001.0-999.9 will frequently be used to describe
(D. Selection of codes 0001.0-999.9)

the reason for the encounter.

These codes are from the section of Icd-9-cm for the clasification of
(D. Selection of codes 0001.0-999.9)

diseases and injury

codes that describe signs and symptoms as oposed to definitive diagnoses are
(E. Codes that describe the signs and syptms)

acceptable for reporting purposes when the physician has not documented an established or confirmed diagnosis

Factors influencing Health Status and contact with Heath services (vcodes) is

provided to deal with occasions when circumstances other than diseases or injury are recoreded as diagnosis or problems

A three digit disease code is to be assigned only if it is not

further subdivided

Where fourth digit subcategories or fifth-digit subclassifications are provided

they must be assigned

A code is invalid if it has not been

coded to the full number of digit required for that code

Sequencing Icd-9-cm diagnoses

report first the ic9cm code for the diagnosis , condition, problem, or other reason for encounter/visit shown in the medical record to be cheifly responsible for the serivces provided

Next report additonal codes that describe
(Sequencing Icd-9-cm diagnoses)

coexisting conditions that were treated or medically managed or that influenced the treatment of the patient during the encounter

qualified diagnosis is a

qorking diagnosis that is not yet proven or established

Terms and phrases associated with qualified diagnosis include

suspected, rule out, possible, probable, questionable, suspicius for, and ruled out

For office visits do bot assign an Icd 9 cm code to qualified diags. instead,

code the signs and or symptoms documentes in the patients chart

Chronic diseases

treated on an ongoing basis may be coded and reported as many times as the patient recieves treatment and care for the codition (s)

Code all documented conditions that coexist at the time of

the encounter/visit and require or affect patient care treatment or management

For patients recieving preoperative evaluation only,

assign the appropiate subclassification code

Assign an additional code to the condition that describes the reason for

the surgery

Also, assign additional codes to any findings discovered

during the preoperative evaluation

For Ambulatory Surgery (or Outpatient surgery) assign a code to the diagnosis

for which the surgery was performed

If the postoperative diagnosis is diffrent from the preoperative diganisis when the diag. is confirmed assign a code
(For Ambulatory Surgery (or Outpatient surgery)

to the postoperative diagnosis instead (bc its more definitive)

For routine outpatient prentaal visits when no complications are present, report code V22.0 (supervision of normal first pregnancy) or

V22.1 (supervision of other normal pregnancy) as the first listed diag.

The tabular list of diseases and idex to diseases is used

to code diagnosis

The index to Procedures and tabular list of procedures is used by

hospitals to code inpatient procedures

To make the coding procedure esier publishers often place the

Index to diseases in front of the tabular list of diseases

V codes are located in the Tabular list of diseases and are assigned
(Supplementary classifications: Vcodes and E codes)

for patient encounters when a circumstance other than a disease or injury is present

Exs of V codes:
(Supplementary classifications: Vcodes and E codes)

removal of a cast applied by another physician (V54.89) , Exposure to terberculossi (V01.1)

E codes also located in the tabular list of diseases describe
(Supplementary classifications: Vcodes and E codes)

external causes of injury, or other adverse reactions affecting a patients health

Classification of Industrial Accidents According to Agency (found in Appendix D of icd 9 cm) is based on employment injurey statistics adopted by

the tenth international conference of labor statisticans

Because it may be dificult to locate the e code entry in the icd 9 cm indesx to external causes, coders may
(Classification of Industrial Accidents According to Agency )

find the industrial accidents according to agency appendix more helpful

List of three-digit Categories

contains a breakdown of three-digit category codes organized beneath section headings

Index to diseases- This index includes two official tables
(Index to Diseases ( Vol. 2)

that make it easier to code hypertension and neoplasms

Table of drugs and chemicals are
(Index to Diseases ( Vol. 2)

coded by refering to this table

Index to external causes
(Index to Diseases ( Vol. 2)

is helpful to mark it with a tab as a reminder of usefullness

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