1. Slide 1 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. CHAPTER 11 CHAPTER-SPECIFIC GUIDELINES (ICD-9-CM CHAPTERS 1-8)

2. Slide 2 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. ICD-9-CM, Chapter 1 Infectious and Parasitic Diseases –Divided based on _______ (cause of disease) –Many combination codes –Example: 112.0 candidiasis infection of mouth, which reports both ________ and condition with one code etiology organism

3. Slide 3 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Multiple Codes Sequencing must be considered –UTI due to Escherichia coli 599.0 (UTI) etiology 041.4X (E. coli) organism –041 category is a secondary-code only

4. Slide 4 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.1.a,d,e Human Immunodeficiency Virus Code HIV or HIV-related illness ONLY if stated as ________ in diagnostic statement 042 HIV or HIV-related illness ___ Asymptomatic HIV status 795.71 Nonspecific HIV serology Once an HIV diagnosis cannot code V08 confirmed V08

5. Slide 5 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.1.a.2.f. Previously diagnosed HIV-related illness Code prior diagnosis HIV-related disease 042 (HIV) NEVER assign these patients to: –V08 ( ____________ ) or –795.71 ( ___________ serologic evidence of HIV) asymptomatic Nonspecific

6. Slide 6 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.1.a.2. Selection and sequencing of HIV codes If admitted for HIV-related illness (e.g., pneumonia) –Code 042 (HIV) –Followed by current illness (pneumocystic carinii, 136.3) If admitted for other than HIV-related illness –Code ________ diagnosis –Then 042 (HIV) first-listed (Cont’d…)

7. Slide 7 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.1.a.2. Selection and sequencing of HIV codes (…Cont’d) Sequence Reason most responsible for encounter, if HIV (042) –Any additional diagnosis that impacts treatment

8. Slide 8 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.1.a.2.g. HIV infection in Pregnancy, Childbirth and the Puerperium Exception to HIV sequencing During pregnancy, childbirth, or puerperium, code: –647.6X (Other specified infections and parasitic diseases) –Followed by 042 (HIV) (stated diagnosis) –Then any HIV-related illness (Cont’d…)

9. Slide 9 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.1.a.2.g. HIV and Pregnancy (…Cont’d) Asymptomatic HIV during pregnancy, childbirth, or puerperium –647.6X (Other specified infections and parasitic diseases) and –___ (Asymptomatic HIV infection status) V08

10. Slide 10 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.1.a.2.e. Patients with inconclusive HIV serology ______ (Inconclusive serologic test for HIV) 795.71

11. Slide 11 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.1.a.2.h. Encounters for testing for HIV Code V73.89 (Screening for other specified viral disease) –Patient in high-risk group for HIV –_____ (Other problems related to lifestyle) Patients returning for HIV screening results = ______ (HIV counseling) V69.5 V65.44

12. Slide 12 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Caution Incorrectly applying these HIV coding rules can cause patient hardship –Insurance claims for patients with HIV usually need patient’s written agreement to disclose

13. Slide 13 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.1.b. Septicemia, Septic Shock and SIRS _________: systemic disease of microorganisms or their toxins in the blood (blood poisoning) __________: cardiovascular failure due to sepsis SIRS: Systemic Inflammatory Response Syndrome is a systemic response to infection/trauma Sepsis refers to SIRS due to infection Severe sepsis is sepsis with acute organ dysfunction Septicemia Septic shock (Cont’d…)

14. Slide 14 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.1.b. Septicemia, Septic Shock and SIRS (…Cont’d) Code septicemia (______) SIRS second (995.9X) If documented, septic shock (785.52) should be reported Sepsis and septic shock associated with OB codes, also use code 630-633, Ectopic and _____ Pregnancy Septic shock is never primary or first-listed diagnosis 038.XX Molar

15. Slide 15 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Sepsis and Severe Sepsis not associated with noninfectious process Infection resulting from Trauma, Other Serious Injury, Pancreatitis –Code Trauma/Injury –SIRS second (995.9X) –Any acute organ dysfunctions When sepsis or severe sepsis is PDx, sequence systemic infection & sepsis codes before non-infectious condition

16. Slide 16 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. ICD-9-CM, Chapter 2 Neoplasm Two steps for coding neoplasms: 1.Index: Locate histologic type of neoplasm (e.g., sarcoma, melanoma) Review all instructions 2.Locate code identified (usually in ________ Table in Index) by body site Neoplasms Table divided into columns: 1.Malignant (primary, ________, Ca in situ) 2.Benign 3.________ behavior 4.Unspecified Neoplasm secondary Uncertain

17. Slide 17 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. ICD-9-CM, Chapter 2 Neoplasm Morphology Codes-Appendix A ICD-9-CM Codes are alpha numeric: M + 4 numeric characters, a slash, followed by 5 th digit (indicates behavior) Assigned by tumor registry coder /0= Benign /1= Uncertain benign/malignant/borderline /2=Carcinoma in situ /3= Malignant, primary site /6= Malignant, secondary/metastatic site /9= Malignant, uncertain if primary/secondary site Not assigned in outpatient setting

18. Slide 18 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.2. Neoplasms Treatment directed at malignancy: Neoplasm is first-listed diagnosis –Except for ____________ or radiotherapy: 1. Therapy (treatment) 2. Neoplasm Chemotherapy: _____ —encounter for reason the patient presents for treatment, #1 diagnosis Radiotherapy: _____ —encounter for reason the patient presents for treatment, #1 diagnosis chemotherapy V58.11 V58.0 (Cont’d…)

19. Slide 19 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.2. Neoplasms (…Cont’d) Surgical removal of neoplasm and subsequent chemotherapy or radiotherapy –Code _________ as first-listed diagnosis Surgery to determine extent of malignancy –Code __________ as first-listed diagnosis –Code neoplasm as long as patient is receiving treatment or medication following excision malignancy (Cont’d…)

20. Slide 20 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.2. Neoplasms V10, “ ________ history of malignant neoplasm” if –Neoplasm was previously ________________ –No longer being ______ Personal destroyed/removed treated (Cont’d…) (…Cont’d)

21. Slide 21 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.2. Neoplasms (…Cont’d) If patient receives treatment for secondary neoplasm (_________): –Secondary neoplasm is ________ diagnosis –Even though primary is known –Code primary neoplasm as secondary diagnosis or if no longer treated code personal history of... metastasis first-listed (Cont’d…)

22. Slide 22 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.2. Neoplasms (…Cont’d) Admission for symptoms of primary or secondary neoplasm –Malignancy ________ diagnosis –Do NOT code _________ or signs First-listed is site receiving treatment If both primary and mets are treated, code primary as first-listed first-listed symptoms (Cont’d…)

23. Slide 23 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.2. Neoplasms (…Cont’d) Patient treated for anemia or dehydration due to neoplasm or therapy Code –Anemia or dehydration –Neoplasm Patient admitted for pain control due to neoplasm, ____ 338.3 (Cont’d…)

24. Slide 24 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.2. Neoplasms (…Cont’d) Patient admitted to repair complication of surgery for an intestinal malignancy –___________ first-listed diagnosis Complication is reason for encounter –_________ secondary diagnosis Complication Malignancy (Cont’d…)

25. Slide 25 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. V Codes and Neoplasms Patient receiving chemotherapy or radiotherapy post-op removal of neoplasm Code: 1._______ 2.Active neoplasm still being treated Do NOT report H/O ( ________ ) neoplasm Therapy history of

26. Slide 26 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. ICD-9-CM, Chapter 3 Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders

27. Slide 27 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Disorders of Other Endocrine Glands Diabetes Mellitus 250 coded frequently –Subterms often have two codes –Example: 1. Diabetic iritis 250.5X for diabetes (etiology) 2. [364.42] for iritis (manifestation) Metabolic manifestation only one code assignment, e.g., diabetic ketoacidosis (250.1X) (Cont’d…)

28. Slide 28 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Disorders of Other Endocrine Glands (…Cont’d) Fifth digit indicates type of diabetes –Adult or juvenile 0, 2: Type __ 0 Type 2 or unspecified type, not stated as uncontrolled 2 Type 2 or unspecified type uncontrolled 1, 3: Type _ 1 Juvenile type, not stated as uncontrolled 3 Juvenile type, uncontrolled 2 1 (Cont’d…)

29. Slide 29 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Disorders of Other Endocrine Glands ( …Cont’d) Type 1—Insulin dependent—pancreas does not produce insulin Type 2—non-insulin dependent—(can be on insulin) “Uncontrolled”—must be documented by physician –Can use “out of control” –Cannot assign “uncontrolled” status when documentation states “poorly controlled” (Cont’d…)

30. Slide 30 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Disorders of Other Endocrine Glands (…Cont’d) ______ in addition to diabetes code to indicate long-term use of insulin If type is not indicated, code Type __ diabetes Patient with Type __ diabetes can receive insulin Type _ diabetic is insulin dependent V58.67 2 2 1

31. Slide 31 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Other Metabolic and Immunity Disorders Section Disorders such as gout and dehydration Disorders often have many names –242.0X Toxic diffuse goiter also known as: Basedow’s disease Graves’ disease Primary thyroid hyperplasia

32. Slide 32 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. ICD-9-CM, Chapter 4 Diseases of Blood and Blood-Forming Organs Short chapter with 10 sections Includes anemia, blood disorders, coagulation defects (Cont’d…)

33. Slide 33 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Chapter 4 (…Cont’d) Often used code, anemia Many different types of anemia: –_________ hemolytic (282) –____ deficiency (280) –_______ hemolytic (283) Multiple coding often necessary Identify underlying disease condition Hereditary Iron Acquired (Cont’d…)

34. Slide 34 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Chapter 4 (…Cont’d) Two confusing anemias: anemia of chronic disease –disease causing anemia is chronic –Code 285.2X and then the appropriate code for the chronic disease chronic simple anemia –Anemia (285.9), chronic simple (281.9)

35. Slide 35 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. ICD-9-CM, Chapter 5, Mental, Behaviorial and Neurodevelopmental Disorders Includes codes for –Personality disorders –Stress disorders –Neuroses –Psychoses –Sexual deviation/dysfunction, etc. –Intellectual disabilities (Cont’d…)

36. Slide 36 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Chapter 5 (…Cont’d) Fifth digit = status of episode Example: 304, Drug dependence has following fifth digits: 0: __________ (episode) 1: continuous 2: episodic 3: in ________ unspecified remission

37. Slide 37 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. ICD-9-CM, Chapter 6 Diseases of Nervous System and Sense Organs –Central Nervous System –Peripheral Nervous System –Disorders of Eye and Adnexa –Diseases of Ear and Mastoid Process

38. Slide 38 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Pain not elsewhere classified (338) Acute or chronic pain due to: –Trauma –Postoperative –Neoplasm –Psychosocial dysfunction NOT for generalized or localized pain First-listed/primary diagnosis –When definitive diagnosis not established –Pain management is reason for encounter/admission

39. Slide 39 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. ICD-9-CM, Chapter 7—Diseases of Circulatory System Three types of hypertension: –_________ —accelerated –______—continuous, mild (BP↑) controllable, no irreversible vascular changes –__________—NOT indicated as either malignant or benign (.9) Hypertension table located in _____ of ICD-9-CM –Under “H,” Hypertension –Locate now Malignant Benign Unspecified Index

40. Slide 40 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.7.a.1. Hypertension, Essential, or NOS Assign hypertension –arterial –essential –primary –systemic –NOS to 401 Fourth digit to indicate ____, 401.X type

41. Slide 41 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.7.a.2. Hypertension with Heart Disease 402 Category Certain heart conditions when stated “due to hypertension” or implied (“hypertensive”) Add _____ digit for type Use additional code to specify type of heart failure (428) fourth

42. Slide 42 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.7.a.3. Hypertensive Chronic Kidney Disease _____-and- _____ relationship assumed in chronic kidney disease with hypertension Category 403, Hypertensive chronic kidney disease, used when: –__________________________________ With 403 assign fifth digit _ stage I-IV or unspecified and _ for stage V or end stage renal disease Cause effect Category 585 or code 587 are present with hypertension 0 1

43. Slide 43 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.7.a.4. Hypertensive Heart and Chronic Kidney Disease Assign ___ when both hypertensive chronic kidney disease and hypertensive heart disease stated Assume _____-and-_____ relationship Assign ___ digit for mention of heart failure, and/or kidney failure stages I-IV or end stage renal disease –Use additional code from category 428, identifying type of heart disease 404 cause effect fifth

44. Slide 44 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Stages of Chronic Kidney Disease Stage I: Blood flow through kidney increases, kidney enlarges (_____) Stage II: (mild) Small amounts of blood protein (albumin) leaks into urine (microalbuminuria) (_____) Stage III: (moderate) Albumin and other protein losses increase. Patient may develop high BP and kidney’s filter ability (_____) Stage IV: (severe) Large amounts of urine pass through kidney, blood pressure increases (_____) Stage V: Ability to filter waste nearly stops (_____) End stage renal failure (_____) –When documentation indicates chronic renal disease (CKD) and ESRD, report ESRD Unspecified _____ 585.1 585.2 585.3 585.4 585.5 585.6 585.9

45. Slide 45 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.7.a.5. Hypertensive Cerebrovascular Disease Code: _____________ disease (430-438) first Type of hypertension (401-405) ______ Cerebrovascular second

46. Slide 46 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.7.a.6. Hypertensive Retinopathy Code: Hypertensive retinopathy ___ (362.11) Type of hypertension (401-405) ______ first second

47. Slide 47 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.7.a.7. Hypertension, Secondary Hypertension caused by an underlying condition –Code: 1.Underlying condition first 2.Type of hypertension (405) second

48. Slide 48 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.7.a.8. Hypertension, Transient Transient hypertension: _________ elevation of BP DO NOT assign 401-405 Hypertensive Disease –Hypertension diagnosis NOT established –Instead use: _____, Elevated blood pressure 642.3X, ________ hypertension of pregnancy Temporary 796.2 Transient

49. Slide 49 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.7.a.9. Hypertension, Controlled Hypertension controlled by therapy –Assign code from 401-___ 405

50. Slide 50 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.7.a.10. Hypertension, Uncontrolled Untreated hypertension Uncontrolled hypertension Assign code from 401-405

51. Slide 51 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Section I.C.7.a.11. Elevated Blood Pressure Elevated blood pressure coded _____ –Elevated BP reading without hypertension diagnosed –Hypertension NOT stated, NOT coded to 401 (_______ hypertension) 796.2 essential

52. Slide 52 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. ICD-9-CM, Chapter 7—Diseases of Circulatory System Code 410 Acute Myocardial Infarction (MI) requires a fifth digit: “1” Initial episode of care for MI May be reported by more than one facility, if patient transferred “2” Subsequent care Patient re-admitted for testing/treatment within the first eight (8) weeks of initial episode Code 412 reported for old/healed MI –No symptoms

53. Slide 53 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Chapter 8, Diseases of Respiratory System Watch for: “Use additional code to identify infectious organism” –Some codes indicate specific organism and do not need an additional code

54. Slide 54 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Respiratory Failure (RF) Sequencing If RF due to an acute condition (e.g., MI) or acute exacerbation of chronic condition (e.g., COPD) Per new guidelines, if there are no chapter-specific guidelines (OB, poisoning) regarding sequencing, either RF or acute condition may be first-listed diagnosis

55. Slide 55 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Acute Respiratory Infection Section Frequently used codes, such as: –Common cold (___, acute nasopharyngitis) –Sore throat (___, acute pharyngitis) –Acute tonsillitis (___) –Bronchitis (490-491) –Acute upper respiratory infection (_____, URI) –Influenza (___, flu) Read Guidelines for Chapter 8 for specifics on coding COPD and asthma 460 462 463 465.9 487

56. Slide 56 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Conclusion CHAPTER 11 CHAPTER-SPECIFIC GUIDELINES (ICD-9-CM CHAPTERS 1-8)