1. ICD-9-CM with ICD-10 Coding Guidelines
Chapter 4
ICD-9-CM with ICD-10 Coding Guidelines

2. TERM REVIEW
DIAGNOSIS
SIGN
SYMPTOM
MEDICAL NECESSITY
(continued)

3. ICD-9 PROVIDES A CODING SYSTEM THAT PROVIDES
AN ACCURATE WAY TO COLLECT STATISTICS TO:
Keep people healthy
Plan for need health care resources
Record MORBIDITY (disease) data
Record MORTALITY (death) data
Report patients’ conditions on claims
(continued)

4. ICD-9 PROVIDES A CODING SYSTEM THAT PROVIDES
A mandated code set for diagnosis under HIPAA Electronic Health Care Transactions and Code Sets standards. (Codes must be current at the date of the service/patient encounter)
(continued)

5. SEVEN STEPS TO ACCURATE CODING
READ SUPERBILL CAREFULLY
REREAD PHYSICIAN NOTES
ASK QUESTIONS
CODE DIAGNOSIS(ES), SIGNS AND SYMPTOMS
CODE EACH PROCEDURE
LINK EACH PROCEDURE CODE TO AT LEAST 1 DIAGNOSIS
DOUBLE CHECK YOUR CODES
(continued)

6. TERMS
SUPPORTING DOCUMENTATION
UPCODING
UNBUNDLING
DOUBLE BILLING

7. DETERMINING WHAT TO CODE
Raymond went to see Dr Langston because his throat has been scratchy and sore. After examining the patient and taking a throat culture, Dr Langston determines that Raymond has strep throat and writes him a presciption

8. Abstracting Physician’s Notes
What are the patient’s signs and symptoms (chief complaint)?
What is the diagnosis? (Why is the physician caring/treating or providing services for this patient?)

9. ICD-9-CM and ICD-10-CM Official Guidelines for Coding and Reporting
Rules developed by cooperating parties for ICD-9-CM and ICD-10-CM to accompany and complement official conventions and instructions provided within ICD-9-CM and ICD-10-CM
Companion to ICD-9-CM and ICD-10-CM
(continued)

10. CASE STUDY
Darlene Jones broke a drinking glass in her hand. After cleaning it, she went to the doctor because it was still hurting. He removed additional pieces of glass from the wound What is the diagnostic-related key word? (Index/Volume 2)

11. LOOK A LITTLE FURTHER
IS THE GLASS? A SPLINTER? FOREIGN BODY? IS THE LOCATION OF THE WOUND IN- HER HAND? IN SOFT TISSUE?

12. WHAT IS YOUR DIAGNOSIS CODE?

13. HIPAA Alert!
HIPAA regulations require providers and third-party payers to adhere to ICD-9-CM Official Guidelines for Coding and Reporting
Violation of coding guidelines is violation of HIPAA

14. FUTURE OF ICD-9
Effective October 1, 2014, ICD-10-CM/PCS replaces ICD-9-CM

15. ICD-9 Official Guidelines for Coding and Reporting
Organized in FOUR sections
Section I ( Conventions, General Coding Guidelines, and Chapter –specific Guidelines)
Section II (Selection of Principle Diagnosis)
Section III (Reporting Additional Diagnosis)
Section IV- (Diagnostic Coding and Reporting Guidelines for Outpatient Services)

16. GUIDELINES FOR CODING AND REPORTING
Contain rules that accompany and complement the official conventions and instructions provided within icd-9
Based on coding and sequencing instructions in the coding manual

17. GUIDELINES FOR CODING AND REPORTING
Assists the physician and coder to accurately code patient visit (achieve complete and accurate documentation, code assignment, and reporting of diagnosis and procedures

18. ICD-9 Official Guidelines for Coding and Reporting
PAGES 1-2 (ICD-9)
-Section I ( Conventions, General Coding Guidelines, and Chapter –specific Guidelines)
Section II (Selection of Principle Diagnosis (OP SETTINGS))
Section III (Reporting Additional Diagnosis (NON-OP SETTINGS))
Section IV- (Diagnostic Coding and Reporting Guidelines for Outpatient Services)

19. ICD-9 Official Guidelines for Coding and Reporting
PAGES 3-31 (ICD-9) APPENDIX 1- (PRESENT ON ADMISSION REPORTING GUIDELINES)

20. General Guidelines
Use both Index to Diseases and Tabular List of Diseases
Locate term in Index to Diseases first and verify code in Tabular List of Diseases
Assign highest level of digits available

21. Guidelines
Signs and symptoms integral to disease should not be assigned as additional codes EXAMPLE 1: Hearing loss, fever, swollen axillary lymph nodes, and infective otitis externa, left ear What is the SYMPTOM? SIGN? What does axillary lymph nodes have to do with the other symptoms?
(continued)

22. EXAMPLE 1 (CON’T)
Signs and symptoms integral to disease should not be assigned as additional codes What ICD-9 codes are assigned to this patient visit?
(continued)

23. Guidelines
Etiology and manifestation convention requires two codes to be reported to completely describe a single condition EXAMPLE: Peripheral neuropathy DUE TO type 2 diabetes mellitus 1)What is the main term found in the index? 2) What is the subterm?
(continued)

24. Example: Peripheral neuropathy DUE TO type 2 diabetes mellitus
What are the codes chosen? Why are they in a certain order? Which code points to the manifestation of the disease? Etiology and manifestation convention requires two codes to be reported to completely describe a single condition
(continued)

25. Guidelines Multiple coding Acute (or subacute) and chronic conditions
Use additional code
Code first
If applicable, code any causal condition first
Acute (or subacute) and chronic conditions
Combination code versus multiple code

26. Late Effect
Residual condition that develops after acute phase of illness or injury has ended
No time limit on reporting
EXAMPLE:
Osteoarthritis of left hand due to previous crush injury
1) What is the residual condition?
2) What is the late effect condition?
3) How is this example coded?

27. Chapter 2: Neoplasms ICD-9-CM: 140-239 ICD-10-CM: C00-D499 Neoplasm
“New growths or tumors in which cell reproduction is out of control”
Benign
Malignant
(continued)

28. Revisiting Neoplasms Six classifications: Primary malignancy
Secondary malignancy
Carcinoma (CA) in situ
Benign
Uncertain behavior
Unspecified nature
(continued)

29. Revisiting Neoplasms How to use the Neoplasm Table Review example
Assigning code(s) from the neoplasm table
Primary and secondary malignancies
Sequencing the neoplasm codes
(continued)

30. Revisiting Neoplasms
Cancer described as, “metastatic to a site” is considered SECONDARY to the site. Assign one code to the secondary site and a second code to the specified primary site or unknown primary site
(continued)

31. Revisiting Neoplasms
EXAMPLE 1: Metastatic carcinoma from breast to lung Code (s)? EXAMPLE 2: Metastatic carcinoma from breast
(continued)

32. Chapter 2: Neoplasms
When anatomic sites are documented as metastatic, assign secondary neoplasm code(s) to those sites and assign an unspecified site code to the primary malignant site
EXAMPLE 1:
Primary renal cell carcinoma of lung. Code(s)?
EXAMPLE 2:
Metastic osteosarcoma of brain. Code(s)?

33. Chapter 2: Neoplasms
If the diagnostic statement does not specify whether the neoplasm site is primary or secondary, consider the site as PRIMARY, except for the following sites which are considered secondary sites (unless the physician states it is a primary site):
Bone Brain Diaphragm Heart Liver
Lymph Nodes Mediastinum Meninges
Pleura (NOT LUNG) Neoplasms (Category 195)
Retroperitoneum Spinal cord

34. Chapter 2: Neoplasms
If the cancer diagnosis does not contain documentation of the anatomic site but the term metastatic is documented, assign the codes for “unspecified site” for both the primary and the secondary sites Example 1: Metastatic chromophobe adenocarcinoma Code(s)?

35. Chapter 2: Neoplasms
If the primary site of malignancy is no longer present and no further treatment is directed to the site, DO NOT assign the code for primary of unspecified site. Classify the previous primary site by assigning the appropriate code from Category V10 Example 1: Metastatic carcinoma to right lung from right breast (left radical mastectomy performed last year) Code(s)?

36. Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders
ICD-9-CM:
ICD-10-CM: D50-D89
Diabetes mellitus (5th digit needed to determine)
Type 1
Patient’s body unable to produce insulin
Type 2
Patient’s body unable to properly use insulin produce
Controlled/uncontrolled?
Manifestations?

37. Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders
Complete (Textbook) Exercise 4.5

38. Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders
Homework examples: Premature menopause Code? Postsurgical testicular hypofunction

39. Chapter 4: Diseases of the Blood and Blood-Forming Organs
ICD-9-CM:
ICD-10-CM: D50-D89
Hematopoiesis
Anemia
Red cell volume
Hemoglobin content
(continued)

40. Chapter 4: Diseases of the Blood and Blood-Forming Organs
Shape (morphology)
Purpura
Homework :
Pancytopenia, congenital

41. Chapter 5: Mental Disorders
ICD-9-CM:
ICD-10-CM: F01-F99
WHO guidelines
When classifying behavioral disorders, organically based illnesses reported before functional illnesses
Within functional group, classify disorders as psychoses, neuroses, personality disorders, and others
(continued)

42. Chapter 5: Mental Disorders
WHO guidelines
When coding mental illnesses associated with physical conditions, assign as many codes as necessary to fully describe clinical picture
New for ICD-10-CM
Pain disorders in psychological factors

43. Chapter 6: Nervous System and Sense Organs
ICD-9-CM:
ICD-10-CM: G00-G99, H00-H95
Nervous system, including meninges
Central nervous system
Brain
Spinal cord
Peripheral nervous system

44. Chapter 7: Circulatory System
ICD-9-CM:
ICD-10-CM: I00-I99
Hypertension, hypertensive table
Malignant (accelerated)
Benign
Unspecified
COMPLETE Exercise 4.9 (textbook page 162)
HOMEWORK-
Right heart failure
Benign hypertension
(continued)

45. Chapter 7: Circulatory System
Cerebral infarction, stroke, CVA
Late effects of cerebrovascular disease
Myocardial infarction

46. Chapter 8: Respiratory System
ICD-9-CM:
ICD-10-CM: J00-J99
Nose, sinuses, pharynx, larynx, trachea, bronchi, and lungs
Chronic obstructive pulmonary disease
Refer to main term “obstruction”
(continued)

47. Chapter 8: Respiratory System
Pneumonia
Asthma (status asthmaticus)
Acute exacerbation

48. Chapter 9: Digestive System
ICD-9-CM:
ICD-10-CM: K00-K94
Major digestive organs include pharynx, esophagus, stomach, and intestines
Accessory (secondary) organs include salivary and parotid glands, jaw, and teeth
(continued)

49. Chapter 9: Digestive System
Structures that support digestive process are gallbladder, pancreas, and liver
HOMEWORK
Reacurring femoral hernia, with gangrene, unilateral

50. Chapter 10: Genitourinary System
ICD-9-CM:
ICD-10-CM: N00-N99
Chronic kidney disease (CKD)
Kidney transplant status
ICD-9-CM: V42.0
ICD-10-CM: Z94.0
CKD with other conditions

51. Chapter 11: Pregnancy, Childbirth, and Puerperium
ICD-9-CM:
ICD-10-CM: O00-O9A
Conditions occurring during pregnancy, childbirth, and six weeks immediately following childbirth
Never report these codes on baby’s record
(continued)

52. Chapter 11: Pregnancy, Childbirth, and Puerperium
Outcome of delivery
ICD-9-CM: V27.0-V27.9
ICD-10-CM: Z37.1-Z37.9
(continued)

53. Chapter 11: Pregnancy, Childbirth, and Puerperium
ICD-9-CM: (ectopic or molar pregnancy)
ICD-10-CM: O00-O02
(continued)

54. Chapter 11: Pregnancy, Childbirth, and Puerperium
ICD-9-CM: 639 (complications following abortion and ectopic or molar pregnancy)
ICD-10-CM: O08
Fifth digits to identify abortive stage
Unspecified (0)
Incomplete (1)
Complete (2)
(continued)

55. Chapter 11: Pregnancy, Childbirth, and Puerperium
ICD-9-CM: (complications related to pregnancy)
(continued)

56. Chapter 11: Pregnancy, Childbirth, and Puerperium
ICD-9-CM: 650 (normal delivery)
ICD-10-CM: O80
Minimal or no assistance
Episiotomy permitted
Fetal manipulation not permitted
e.g., use of forceps
(continued)

57. Chapter 11: Pregnancy, Childbirth, and Puerperium
Except for ICD-10-CM, 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)

58. Chapter 12: Skin and Subcutaneous Tissue
ICD-9-CM:
ICD-10-CM: L00-L99
Epidermis, dermis, subcutaneous tissue, nails, sebaceous glands, sweat glands, hair, and hair follicles

59. Chapter 13: Musculoskeletal System and Connective Tissue
ICD-9-CM:
ICD-10-CM: M00-M99
Bones, muscles, cartilage, fascia, ligaments, synovia, tendons, and bursa
(continued)

60. Chapter 13: Musculoskeletal System and Connective Tissue
Localized osteoarthrosis
Primary
Unknown etiology
Secondary
Caused by external or internal injury

61. Chapter 14: Congenital Anomalies
ICD-9-CM:
ICD-10-CM: Q00-Q99
Classifies all conditions according to principal or defining defect rather than cause
Except for chromosome abnormalities
(continued)

62. Chapter 14: Congenital Anomalies
May be apparent at birth or hidden and identified sometime after birth
Codes may used throughout patient’s life

63. Chapter 15: Conditions Originating in Perinatal Period
ICD-9-CM:
ICD-10-CM: P00-P96
Perinatal period
Interval of time before, during, and up to 28 days following birth
Never report these codes for mother’s episode of care

64. Chapter 16: Symptoms, Signs, and Ill-Defined Conditions
ICD-9-CM:
ICD-10-CM: R00-R99
Includes symptoms, signs, and abnormal results of laboratory or other investigative procedures
(continued)

65. Chapter 16: Symptoms, Signs, and Ill-Defined Conditions
Key terms
Abnormal, abnormality
Decrease, decreased
Elevation
Findings, abnormal, without diagnosis

66. Chapter 17: Injury and Poisoning
ICD-9-CM:
ICD-10-CM: S00-T98
Injuries
Fractures
Burns
Adverse effects, poisonings, and toxic effects

67. Fractures Open/compound fracture Closed/simple fracture Comminuted
Depressed
Fissured
Greenstick
Impacted
(continued)

68. Fractures Closed/simple fracture Complicated Malunion (late effect)
Linear
Slipped epiphysis
Spiral fracture
Complicated
Malunion (late effect)

69. Burns ICD-9-CM: 940-949 ICD-10-CM: T20-T32 Classified according to:
Depth
First degree (erythema)
Second degree (blistering)
Third degree (full thickness)
(continued)

70. Burns Classified according to: Extent
Percentage of body surface
Agent (e.g., chemicals, fire, sun)
E codes assigned

71. Adverse Effects Also known as adverse reactions
Appearance of pathologic condition caused by ingestion or exposure to chemical substance properly administered or taken
e.g., allergic rash due to penicillin
Table of Drugs and Chemicals

72. Poisonings Occur as result of overdose
Wrong substance administered/taken or intoxication that involves combining prescribed drugs with nonprescribed drugs or alcohol
e.g., coma due to overdose of codeine
(continued)

73. Poisonings ICD-9-CM: 960-979 ICD-10-CM: T36-T65
Manifestation of poisoning

74. Toxic Effects ICD-9-CM: 980-989 ICD-10-CM: T51-T65
When someone ingests or comes into contact with harmful substance

75. V Codes ICD-9-CM: V01-V85 ICD-10-CM: A00-Y99
Supplementary Classification of Factors Influencing Health Status and Contact with Health Services
(continued)

76. V Codes
Classifies occasions when circumstances other than disease or injury recorded as diagnoses or problems
(continued)

77. V Codes Categories: Contact/exposure Inoculations and vaccinations
Status
History (of)
Screening
Observation
Aftercare
(continued)

78. V Codes Categories: Routine and administrative examinations
Follow-up
Donor
Counseling
Obstetrics and related conditions
Newborn, infant, and child
Routine and administrative examinations
Miscellaneous

79. E Codes ICD-9-CM: E800-E999 ICD-10-CM: V00-Y99
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)

80. E Codes
Reported in addition to code from Chapters 1-17 to indicate nature of condition