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ICD 9 CM 2013/2014 Edition

Terms in this set (122)

Diagnosis Code for seizure disorder, recurrent
Answer: 345.9

This is fairly hard question ... you have to use all 5 digits.

Epilepsy is a brain disorder in which a person has repeated seizures. Epilepsy is also called a seizure disorder, and a Seizure Disorder NOS would be coded the same as Epilepsy NOS. However, "Recurrent Seizure Disorder" would not be coded as Epilepsy NOS (unspecified) because it is specified as "Recurrent". Recurrent seizures are an "other" type of epilepsy, are listed in the code description for subcategory 345.8, and are listed as an inclusion term..

Use the ICD-9 Alphabetic Index and Tabular List to find the correct diagnosis code(s). The Alphabetic Index for Seizure, recurrent directs you to code 345.8x. When you look up the subcategory 345.8 in the Tabular Listing, recurrent seizures are included. However, there is a big red dot right in front of the code, indicating that you must use an additional digit. If you look directly under the 345 category, you can see the box that provides definitions for the 5th digit. There is no mention of intractable epilepsy, so the fifth digit should be "0". The correct answer is 345.80.

However, the index is wrong or misleading if you look up Disorder, seizure, recurrent. It directs you in error to code 345.9x. Recurrent seizures were moved from the 345.9 subcategory to the 345.8 subcategory in the ICD-9-CM 2012 edition. There have been no revisions to the codes or index since 2012. Once in every several thousand codes, there will be a mistake in the index. That's why it is so important to verify all codes in the Tabular Listing. Also be careful of Google searches because they can lead to a wrong answer. Also be aware the Answer Keys sometimes have not caught up with code revisions. Finally also worth noting is that it can be better to start with the condition as the main term and not "disorder" in the index. (The definition of disorder is an illness or a medical condition... which is how the Alphabetic Index is organized.)
250.80, 607.84
diabetes, with, complication, specified 250.8X (250.80 type 2 not specified as uncontrolled)
dysfunction, erectile 607.84

The erectile dysfunction is stated as due to diabetes so it is a diabetic manifestation. The Alphabetic Index for Diabetes, with, complication, specified directs you to subcategory 250.8. The 5th digit should be '0' for type 2, not specified as uncontrolled. Not all of the possible inclusion terms are listed in the Tabular at subcategory 250.8. If it helps, write in ulcer and impotence (not otherwise specified as neurological or peripheral circulatory disorders). The erectile dysfunction is listed in the Index under Dysfunction, erectile.

(The impotence is not mentioned as being due to a diabetic neurological or peripheral circulatory condition so cannot be coded to either of those classifications. Code 302.72 is for erectile dysfunction of "nonorganic origin", but there is no mention of nonorganic origin so we would not use this code.
Be careful to always list the code for diabetes before the code for the manifestation, as instructed by the Index and the Tabular listings. Be careful that you always use a 5th digit for a code for diabetes. Be careful to use a 5th digit of "2" or "3" only when the physician states or specifies explicitly "uncontrolled" or "out of control". Also, always be careful in the Index that you are not listing a code for Secondary Diabetes (category 249) when it is only diabetes mellitus. The code for the diabetes (not stated as secondary) will be in the 250 category.)
656.61, V27.0, 73.6
pregnancy, management, affected by, LGA large for dates 656.6X
outcome of delivery, single, liveborn V27.0
episiotomy 73.6

The Alphabetic Index for Pregnancy, management affected by, fetal, excessive growth directs you to subcategory 656.6. The Tabular Listing confirms this. This episode is with birth and no mention of postpartum condition so the 5th digit is "1".

You always have to code the outcome of delivery. The outcome of delivery should be V27.0.

You also have to code the episiotomy, 73.6. (The episiotomy also includes the delivery.)

Notice all of the notes included at code 650. Code 650 cannot be used with any other code from Chapter 15 (codes in the range 630-676.) It's not a normal birth (code 650) if there is mention of any condition, including a baby that is large for gestational age.

A lot of codes for pregnancy and delivery are listed under Pregnancy, complicated by and Pregnancy, management affected by. Make sure these listings are very easy to see in your code book.

For assignment of 5th digits in this chapter, remember: 5th digit of '3' would only be used during pregnancy (antepartum) and not ever when there is a delivery or birth; only 5th digits '1' and '2' can be used together; there is no 5th digit of "0"; use a 5th digit of '2' for a delivery occurring with a postpartum condition and '1' for delivery occurring with or without an antepartum condition; and use a 5th digit of '4' for a re-admission for a postpartum condition (not in the same episode of care as the delivery).
654.21, V23.41, V27.0, 73.59
cesarean, previous, affected by management 654.2X
outcome of delivery V27.0
history preterm labor V23.41
delivery 73.59

This could be a tricky one because the pregnancy delivery seems "normal" but extra care is always taken with a patient who has had a previous cesarean delivery. So...

The Alphabetic Index listings for Pregnancy, management affected by, previous, cesarean delivery (also for Delivery, cesarean, previous, cesarean delivery) direct you to subcategory 654.2. The Tabular Listing confirms this. The 5th digit should be '1' for delivery (with or without mention of antepartum condition).

In the Index: History, poor obstetric, pre-term labor (also Pregnancy, management affected by, previous, premature delivery and Pregnancy, complicated by, previous, premature delivery) direct you to code V23.41. The Tabular Listing confirms this code.

You also always have to code the outcome of delivery V27.0 and the procedure for the delivery. The procedure for a normal vaginal delivery is 73.59

Again, notice all of the notes included at code 650. Code 650 cannot be used with any other code from Chapter 15 (codes in the range 630-676.) It's not a normal birth (code 650) if there is mention of any condition, like preterm labor or previous cesarean section.

For assignment of 5th digits in this chapter, remember: 5th digit of '3' would only be used during pregnancy (antepartum) and not ever when there is a delivery or birth; only 5th digits '1' and '2' can be used together; there is no 5th digit of "0"; use a 5th digit of '2' for a delivery occurring with a postpartum condition and '1' for delivery occurring with or without an antepartum condition; and use a 5th digit of '4' for a re-admission for a postpartum condition (not in the same episode of care as the delivery).
644.21, 656.51, V27.0, 73.59

The main circumstance of the delivery is that the patient is 35 weeks pregnant, premature or pre-term labor. The Alphabetic Index for Labor, premature directs you to subcategory 644.2. The Tabular Listing confirms this. A 5th digit with delivery in this case would be "1" delivered (with or without antepartum condition).

The Alphabetic Index for Pregnancy, management affected by, fetal, growth retardation (and other like listings) directs you to code 656.5. The Tabular Listing confirms this. A 5th digit of "1" is appropriate to indicate with delivery (with or without antepartum condition).

You always have to code the outcome of delivery. It should be V27.0 in this case.

You also have to code the vaginal delivery, 73.59.

Again, notice all of the notes included at code 650. Code 650 cannot be used with any other code from Chapter 15 (codes in the range 630-676.) It's not a normal birth (code 650) if there is mention of any other condition. Premature labor and SGA baby prevent 650 from being used.

For assignment of 5th digits in this chapter, remember: 5th digit of '3' would only be used during pregnancy (antepartum) and not ever when there is a delivery or birth; only 5th digits '1' and '2' can be used together; there is no 5th digit of "0"; use a 5th digit of '2' for a delivery occurring with a postpartum condition and '1' for delivery occurring with or without an antepartum condition; and use a 5th digit of '4' for a re-admission for a postpartum condition (not in the same episode of care as the delivery).