ICD-9-CM Chapter 6 test

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Volume 1

Tabular List of diseases

Volume 2

Index to Diseases

Volume 3

Index to procedures and tabular list of procedures.

Neoplasm

also known as Lesion

V Codes

are located in the Tabular List of Diseases and are assigned for patient encounters when a circumstance other than a disease or injury is present.

Examples of V Codes

1.) Removal of a CAST applied by another physician (V54.89)
2.) Exposure to tuberculosis (V01.1)
3.) Personal history of breast cancer (V10.30
4.) Well-baby checkup (V20.2)
5.) Annual physical examination (V70.0)

E Codes

also located in the Tabular List of Diseases, describe EXTERNAL causes of Injury, poisoning or other adverse reactions affecting a patient's health. They are reported for ENVIRONMENTAL events, industrial accidents, injuries inflicted by criminal activity.

E Codes

are indexed in the Index to EXTERNAL Causes

ICD

International Classification of Diseases

Medicare Catastrophic Coverage Act of 1988

Private payers adopted similar diagnosis coding requirements for claims submission in subsequent years

V Codes

Supplementary Classification of Factors Influencing Health status and contact w/health services (V01-89) and other than disease or injury.

E Codes

Supplementary classification of EXTERNAL causes of injury and poisoning (E8090-E999)

mortality

Death

Purpose

the procedur or service is performed to treat a medical condition.

Scope

the most appropriate level of service is provided, taking into consideration potential benefit and harm to the patient.

Evidence

the treatment is known to be effective in improving health outcomes.

Value

the treatment is cost-effective for this condition when compared to alternative treatments, including no treatment.

Coding Tip

Begin the search for the correct code by referring to the Index to Diseases. Never begin searching for a code in the Tabular List of Diseases because this will lead to coding errors.

Out Patient Settings

the term first-listed diagnosis is used (instead of the inpatient setting's principal diagnosis.

Diagnosis

are often not established at the time of the patient's initial encounter or vist, (2) two or more visits may be required before the diagnosis is confirmed.

Outpatient

a person treated in one of four settings.

Ambulatory surgery center (ASC)

where the patient is released prior to a 24-hour stay (length of stay must be 23 hours, 59 minutes and 59 seconds or less)

Healthcare providers office

Physician

Hospital clinic

emergency department, outpatient department, same day surgery unit (length of stay must be 23 hours, 59 minutes and 59 seconds)

Hospital Observation

where the patient's length of stay is: 23 hours, 59 minutes and 59 seconds or less (commercial insurance) (unless documentation for additional observation is medically justified) (24-48 hours (Medicare)

Inpatient

a person admitted to a hospital or long-term care facility (LTCF); or residential care, if LTCF)

outpatient

setting's first-listed diagnosis IS NOT called the PRIMARY DIAGNOSIS.

Comorbidity

is a concurrent condition that co-exists with the first-listed diagnosis (outpatient care)

Complication

is a condition that develops after outpatient care has been provided {ruptured sutures after office surgery} or during an inpatient

Level of Detail in Coding

disease codes containg (3) three, (4) four and five digits.

Three Digits

disease code is to be ASSIGNED ONLY if it IS NOT further subdivided.

Fourth digit

is the SUBCATEGORIES

Fifth digit

subclassifications are provided, they must be assigned.

Invalid Code

if it HAS NOT been coded to the full number of digits required for that code.

Four Appendices are

APPENDIX A -Morphology of Neoplasms (M Codes); APPENDIX C - Classification of Drugs by American Hospital formulary Service List Number and Their ICD-9-CM Equivalents; APPENDIX D - Classification of Industrial Accidents According to Agency; APPENDIX E - List of Three-Digit Categories.

Main Terms

conditions are printed in BOLDFACE and are followed by the code number

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