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Chapter 6 ICD-9 Part 1

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If outdated codes are submitted on claims, providers, and healthcare facilities will incur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)
2) American Health Information Managment Association
(Outpatinet Coding Guidelines)
3)Centers for medicare and medicaid services
(Outpatinet Coding Guidelines)
Cms, formerly HCFA
4) NAtional Center for Health Statistics
(Outpatinet Coding Guidelines)
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