1. INTRODUCTION TO ICD-9 CODING Doctors Hospital Family Practice Residency Program Practice Management

2. Overview of the Course: ◦Why Use ICD-9 ◦What is ICD-9 ◦How is ICD-9 Broken Down ◦Why use Both Volumes of ICD-9 ◦Steps to Coding ◦Other Tips for ICD-9 ◦Comparison of ICD-9 to ICD-10

3. 1. Why use? ◦Physicians and healthcare providers provide services and perform procedures that need to be documented in a standardized fashion ◦Physicians and healthcare providers will assess a patient and make an appropriate diagnosis ◦Services should be captured and billed appropriately for financial success ◦Using numbers is the easiest and best way for information to be standardized and passed along to other associated healthcare providers/insurance carriers

4. 2. What is ICD-9? ◦It is a list of potential diagnoses given to patients, and the respective numeric code that is assigned to it ◦Example: 401.9 (Essential Hypertension) ◦Are up to 5 digits long – example – 707.11 (Ulcer of the calf) ◦ICD-9 stands for “International Classification of Disease- 9 th Revision” ◦In practice – you will use the ICD-9-CM (ICD-9 Clinical Modification) ◦It is based upon the codes used by the World Health Organization ◦It is regulated in the United Stated by the National Committee for Health Statistics (NHCS) and the Centers for Medicare and Medicaid Services (CMS) ◦The groups above are in charge of any changes to ICD-9 ◦Revisions in the Codes take place each October 1 st ◦COMING SOON: There is to be a transition to ICD-10 on October 1 st, 2015 (more on this later in the lecture)

5. 3. How is ICD-9 broken down? ◦Broken down into Volumes 1-3 ◦Volume 1 and 2 are most important to use in outpatient primary care (volume 3 is for hospital procedures) ◦Volume 1 (located behind volume 2) – is a tabular list of the numeric codes ◦Arranged from the lowest code (001) through the highest (999.9) ◦Tells you the specifics of each code (what conditions are included or excluded) ◦Also lists the “V codes” and “E codes” ◦V – codes – circumstances related to the health status of an individual – not necessarily a condition (for example - V58.69 – long term use of high risk meds) ◦E – codes – circumstances related to an injury (for example - E919.0 – accident caused by agricultural machines) ◦Volume 2 – is an alphabetical index of the diagnoses (From AAT – alpha 1 antitrypsin deficiency through to zygomycosis) along with the respective numeric codes

6. 4. How is ICD-9 broken down? ◦Spend some time to familiarize yourself with the ICD-9 Code Book now ◦What is the code for acute epigastric abdominal pain? ◦What is the code for acute idiopathic pericarditis? ◦What is the code for enteritis due to adenovirus infection? ◦Challenge: what is the code for elevated liver enzymes?

7. 5. Why both Volumes? ◦Volume 2 helps you first identify a code ◦many Electronic Health Records now have a search feature to help select an appropriate code by simply typing in a key word – instead of looking it up using volume 2 ◦For example – typing “Diabetes” in a EMR search window to allow several types of diabetes numeric codes to appear with descriptors in the same search window ◦Volume 1 helps you then further select the “BEST CODE” to the “HIGHEST SPECIFICITY” ◦Example: A well controlled type II diabetic patient with neurological complications presents to the office for followup ◦Looking in Volume 2 (in the front of the book) – allows you to find that 250 is the code to use ◦Looking in Volume 1 (in the back of the book) – allows you to find that 250 is further divided by type, and based on complications ◦So for Type II diabetes that is well controlled with neurological complications: 250.60 would be the best code to use

8. 6. Steps to Coding 1.Make the diagnosis 2.Select the appropriate Code from the Volume 2 part (front part – or alphabetical portion - of the ICD-9 book) 3.Then Flip back to Volume 1 – to ensure that the most correct code is used The back of the book will list qualifiers (includes this diagnosis, or excludes another) Determine which is the best code to the highest specificity 4.Report any co-existing conditions 5.Use the alphanumeric list (volume 2) and tabular list (volume 1) together

9. 7. Tips on using ICD-9: o Consistency is the key ◦It is important to be as specific as possible – to describe the diagnosis ◦Be sure to use both sections of the ICD-9 book ◦Document what you do in the progress note ◦The information written down on the notes – will drive the billing for the encounter later (to be discussed under CPT lecture) ◦If things are not documented – then they were not done! ◦Sometimes you have to “think like a coder” – and the listing alphabetically will be under different verbage than you are accustomed to ◦Example – for the question listed above “What is the code for abnormal liver enzyme tests” – you have to look under the following: Findings, abnormal, liver enzymes = 794.8

10. 8. Comparison of ICD-9 and ICD-10 ◦As mentioned above – ICD-10 is coming October 1, 2015 ◦The change is due to limitation of ICD-9 on the number of codes available (we are running out of diagnosis codes in medicine – most notably in the oncology field) ◦ICD-10 will relay more information on the code chosen regarding etiology, anatomic site or severity, along with an extension option for codes for additional information re: the sequel of the encounter, sequel of injuries or external cause ◦What is pushing the change otherwise: ◦In the future – instead of being paid based on Fee for Service model (you do thing X, you bill X, and get paid for X), we may be paid based on the quality or complexity of care given – and ICD-10 allows for this transition ◦We are the only industrialized nation to still use ICD-9 ◦ICD-10 allows more data mining to improve health (due to notations on anatomic site, severity – etc.) ◦More widespread implementation of Electronic Records will allow for the transition to take place ◦There will be training in ICD-10 to come - prior to implementation!

12. References ◦ICD-9 – CM – for physicians, Volumes 1 and 2 ◦“Introduction to Coding” – by Todd Frieze, MD, FACP, FACE, ECNU, CEC; found at: https://www.aace.com/files/pm101_frieze_introcoding.pdf https://www.aace.com/files/pm101_frieze_introcoding.pdf ◦“Chart comparison of ICD-9 and ICD-10,” found at: http://ncmmis.ncdhhs.gov/files/icd10/icd-10_to_icd- 9_diagnosis_code_final_9-4-12.pdf