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© 2010 Delmar, Cengage Learning Chapter 4 ICD-9-CM Coding Guidelines
© 2010 Delmar, Cengage Learning ICD-9-CM Official Guidelines for Coding and Reporting Rules developed by the cooperating parties for the ICD-9-CM to accompany and complement the official conventions and instructions provided within ICD-9-CM Companion to ICD-9-CM (continued)
© 2010 Delmar, Cengage Learning ICD-9-CM Official Guidelines for Coding and Reporting Cooperating parties consist of: –American Hospital Association (AHA) –AHIMA –CMS –NCHS
© 2010 Delmar, Cengage Learning HIPAA Alert! HIPAA regulations require providers and third-party payers to adhere to ICD-9-CM Official Guidelines for Coding and Reporting. A violation of coding guidelines is a violation of HIPAA.
© 2010 Delmar, Cengage Learning Official Guidelines for Coding and Reporting Four sections: –Section I –Section II –Section III –Section IV
© 2010 Delmar, Cengage Learning Historical Perspective Bertillon International Statistical Classification of Causes of Death International Classification of Diseases (ICD) ICD-9-CM ICD-10-CM and ICD-10-PCS (future)
© 2010 Delmar, Cengage Learning General Guidelines Use both the ICD-9-CM Index to Diseases and the Tabular List of Diseases. Locate term in the Index to Diseases first, and verify the code in the Tabular List of Diseases. Assign the highest level of digits available.
© 2010 Delmar, Cengage Learning Guidelines Signs and symptoms that are integral to the disease should not be assigned as additional codes. The etiology and manifestation convention requires two codes to be reported to completely describe a single condition. (continued)
© 2010 Delmar, Cengage Learning Guidelines Multiple coding –Use additional code –Code first –If applicable, code any causal condition first Acute (or subacute) and chronic conditions Combination code versus multiple code
© 2010 Delmar, Cengage Learning Late Effect Residual condition that develops after acute phase of illness or injury has ended –No time limit on reporting Combination code assigned For example, painful cicatrix following severe burn to the elbow or left-sided paralysis due to previous cerebrovascular accident (CVA)
© 2010 Delmar, Cengage Learning General Procedure Guidelines Based on anatomy rather than surgical specialty Numeric codes Use both Index to Procedures and Tabular List of Procedures (continued)
© 2010 Delmar, Cengage Learning General Procedure Guidelines Index to Procedures main terms organized in alphabetic order according to type of procedure Report codes using highest number of digits available — omit code (continued)
© 2010 Delmar, Cengage Learning General Procedure Guidelines Common key terms: –Application –Closure –Correction –Destruction –Division –Incision –Insertion –Operation –Procedure –Release –Removal –Repair (continued)
© 2010 Delmar, Cengage Learning General Procedure Guidelines Common key terms: –Resection –Revision –Suture –Test –Therapy –Transfer (continued)
© 2010 Delmar, Cengage Learning General Procedure Guidelines Combination codes Multiple codes And/Or Open procedure versus closed procedure Endoscopic procedures Biopsies Canceled surgery
© 2010 Delmar, Cengage Learning Chapter-Specific Guidelines Principal diagnosis Principal procedure Secondary diagnoses Secondary procedures First-listed diagnosis
© 2010 Delmar, Cengage Learning Chapter 1: Infectious and Parasitic Diseases 001–139 Organisms Infections “Supplemental Classification of Factors Influencing Health Status and Contact with Health Services” Human immunodeficiency virus (HIV)
© 2010 Delmar, Cengage Learning HIV Positive Status Key terms: –HIV disease –HIV infection –HIV infected –HIV positive –Acquired immune deficiency syndrome (AIDS)
© 2010 Delmar, Cengage Learning HIV HIV-related conditions and opportunistic infections Sequence HIV code (042) first and then opportunistic infection code Sequencing of HIV codes with admission for unrelated condition (continued)
© 2010 Delmar, Cengage Learning HIV Asymptomatic HIV Inconclusive HIV serology
© 2010 Delmar, Cengage Learning Chapter 2: Neoplasms 140–239 Neoplasm –“New growths or tumors in which cell reproduction is out of control” Benign Malignant (continued)
© 2010 Delmar, Cengage Learning Chapter 2: Neoplasms Six classifications: –Primary malignancy –Secondary malignancy –Carcinoma (CA) in situ –Benign –Uncertain behavior –Unspecified nature (continued)
© 2010 Delmar, Cengage Learning Chapter 2: Neoplasms Contiguous sites (overlapping sites) Re-excision of tumors
© 2010 Delmar, Cengage Learning Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders 240–279 Diabetes mellitus –Type I Patient’s body unable to produce insulin –Type II Patient’s body unable to properly use insulin produced
© 2010 Delmar, Cengage Learning Chapter 4: Diseases of the Blood and Blood-Forming Organs 280–289 Hematopoiesis Anemia Red cell volume Hemoglobin content Shape (morphology) Purpura
© 2010 Delmar, Cengage Learning Chapter 5: Mental Disorders 290–319 WHO guidelines: –When classifying behavioral disorders, organically based illnesses are reported before functional illnesses. –Within a functional group, classify disorders as psychoses, neuroses, personality disorders, and others. (continued)
© 2010 Delmar, Cengage Learning Chapter 5: Mental Disorders WHO guidelines: –When coding mental illnesses associated with physical conditions, assign as many codes as necessary to fully describe the clinical picture.
© 2010 Delmar, Cengage Learning Chapter 6: Nervous System and Sense Organs 320–389 Nervous system, including meninges Central nervous system –Brain –Spinal cord Peripheral nervous system
© 2010 Delmar, Cengage Learning Chapter 7: Circulatory System 390–459 Hypertension, hypertensive table –Malignant (accelerated) –Benign –Unspecified Cerebral infarction, stroke, CVA Late effects of cerebrovascular disease Myocardial infarction
© 2010 Delmar, Cengage Learning Chapter 8: Respiratory System 460–519 Nose, sinuses, pharynx, larynx, trachea, bronchi, and lungs Chronic obstructive pulmonary disease –Refer to main term “obstruction” Pneumonia Asthma (status asthmaticus) Acute exacerbation
© 2010 Delmar, Cengage Learning Chapter 9: Digestive System 520–579 Major digestive organs include pharynx, esophagus, stomach, and intestines Accessory (secondary) organs include salivary and parotid glands, jaw, and teeth Structures that support the digestive process are gallbladder, pancreas, and liver
© 2010 Delmar, Cengage Learning Chapter 10: Genitourinary System 580–629 Chronic kidney disease (CKD) Kidney transplant status (V42.0) CKD with other conditions
© 2010 Delmar, Cengage Learning Chapter 11: Pregnancy, Childbirth, and Puerperium 630–677 Conditions occurring during pregnancy, childbirth, and six weeks immediately following childbirth Never report these codes on baby’s record Outcome of delivery (V27.0–V27.9) (continued)
© 2010 Delmar, Cengage Learning Chapter 11: Pregnancy, Childbirth, and Puerperium 630–633 (ectopic or molar pregnancy) 639 (complications following abortion and ectopic or molar pregnancy) Fifth digits to identify abortive stage –Unspecified (0) –Incomplete (1) –Complete (2) (continued)
© 2010 Delmar, Cengage Learning Chapter 11: Pregnancy, Childbirth, and Puerperium 640–648 (complications related to pregnancy) 650 (normal delivery) –Minimal or no assistance –Episiotomy permitted –Fetal manipulation (e.g., use of forceps) not permitted (continued)
© 2010 Delmar, Cengage Learning Chapter 11: Pregnancy, Childbirth, and Puerperium Fifth digit required for current episode of care –Unspecified as to episode of care (0) –Delivered with or without mention of antepartum condition (1) –Delivered with mention of postpartum complication (2) –Antepartum condition or complication (3) –Postpartum condition or complication (4)
© 2010 Delmar, Cengage Learning Chapter 12: Skin and Subcutaneous Tissue 680–709 Epidermis, dermis, subcutaneous tissue, nails, sebaceous glands, sweat glands, hair, and hair follicles
© 2010 Delmar, Cengage Learning Chapter 13: Musculoskeletal System and Connective Tissue 710–739 Bones, muscles, cartilage, fascia, ligaments, synovia, tendons, and bursa Localized osteoarthrosis –Primary Unknown etiology –Secondary Caused by external or internal injury
© 2010 Delmar, Cengage Learning Chapter 14: Congenital Anomalies 740–759 Classifies all conditions according to a principal or defining defect rather than cause –Except for chromosome abnormalities May be apparent at birth or hidden and identified sometime after birth Codes may used throughout patient’s life
© 2010 Delmar, Cengage Learning Chapter 15: Conditions Originating in Perinatal Period 760–779 Perinatal period –Interval of time before, during, and up to 28 days following birth Never report these codes for the mother’s episode of care
© 2010 Delmar, Cengage Learning Chapter 16: Symptoms, Signs, Ill- Defined Conditions 780–799 Includes symptoms, signs, and abnormal results of laboratory or other investigative procedures (continued)
© 2010 Delmar, Cengage Learning Chapter 16: Symptoms, Signs, Ill- Defined Conditions Key terms: –Abnormal, abnormality –Decrease, decreased –Elevation –Findings, abnormal, without diagnosis
© 2010 Delmar, Cengage Learning Chapter 17: Injury and Poisoning 800–999 Injuries Fractures Burns Adverse effects, poisonings, and toxic effects
© 2010 Delmar, Cengage Learning Fractures Open/Compound fracture Closed/Simple fracture –Comminuted –Depressed –Fissured –Greenstick –Impacted (continued)
© 2010 Delmar, Cengage Learning Fractures Closed/Simple fracture –Linear –Slipped epiphysis –Spiral fracture Complicated Malunion (late effect)
© 2010 Delmar, Cengage Learning Burns 940–949 Classified according to: –Depth First degree (erythema) Second degree (blistering) Third degree (full thickness) –Extent Percentage of body surface –Agent (e.g., chemicals, fire, sun) E codes assigned
© 2010 Delmar, Cengage Learning Adverse Effects, Poisonings, and Toxic Effects Adverse effect (adverse reaction) –Appearance of pathologic condition caused by ingestion or exposure to chemical substance properly administered or taken –For example, allergic rash due to penicillin –Table of Drugs and Chemicals
© 2010 Delmar, Cengage Learning Poisoning Occurs as result of overdose Wrong substance administered or taken or intoxication that involves combining prescribed drugs with nonprescribed drugs or alcohol For example, coma due to overdose of codeine (continued)
© 2010 Delmar, Cengage Learning Poisoning 960–979 Manifestation of poisoning Accidental (E850–E869) Suicide attempt (E950–E952) Assault (E961–E962) Undetermined (E980–E982)
© 2010 Delmar, Cengage Learning Toxic Effects When someone ingests or comes into contact with a harmful substance
© 2010 Delmar, Cengage Learning V Codes (V01–V85) Supplementary Classification of Factors Influencing Health Status and Contact with Health Services Classifies occasions when circumstances other than disease or injury are recorded as diagnoses or problems (continued)
© 2010 Delmar, Cengage Learning V Codes Categories: –Contact/Exposure –Inoculations and vaccinations –Status –History (of) –Screening –Observation –Aftercare (continued)
© 2010 Delmar, Cengage Learning V Codes Follow-up Donor Counseling Obstetrics and related conditions Newborn, infant, and child Routine and administrative examinations Miscellaneous
© 2010 Delmar, Cengage Learning E Codes (E800–E999) Supplemental Classification of External Causes of Injury and Poisoning Classifies environmental events, circumstances, and conditions as cause of injury, poisoning, or other adverse effect (continued)
© 2010 Delmar, Cengage Learning E Codes Reported in addition to a code from Chapters 1–17 to indicate nature of condition Machinery accidents (E919) Late effects of accidents (E929, E959, E969, E977, E989, E999) Transport accidents (E800–E848) (continued)
© 2010 Delmar, Cengage Learning E Codes Place of occurrence (E849) –Describes place where event occurred Not patient’s activity at the time
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