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

2. 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)

3. ICD-9-CM Official Guidelines for Coding and Reporting
Cooperating parties consist of:
American Hospital Association (AHA)
AHIMA
CMS
NCHS

4. 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.

5. Official Guidelines for Coding and Reporting
Four sections:
Section I
Section II
Section III
Section IV

6. 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)

7. 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.

8. 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)

9. 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

10. 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)

11. General Procedure Guidelines
Based on anatomy rather than surgical specialty
Numeric codes
Use both Index to Procedures and Tabular List of Procedures
(continued)

12. 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)

13. General Procedure Guidelines
Common key terms:
Application
Closure
Correction
Destruction
Division
Incision
Insertion
Operation
Procedure
Release
Removal
Repair
(continued)

14. General Procedure Guidelines
Common key terms:
Resection
Revision
Suture
Test
Therapy
Transfer
(continued)

15. General Procedure Guidelines
Combination codes
Multiple codes
And/Or
Open procedure versus closed procedure
Endoscopic procedures
Biopsies
Canceled surgery

16. Chapter-Specific Guidelines
Principal diagnosis
Principal procedure
Secondary diagnoses
Secondary procedures
First-listed diagnosis

17. 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)

18. HIV Positive Status Key terms: HIV disease HIV infection HIV infected
Acquired immune deficiency syndrome (AIDS)

19. 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)

20. HIV
Asymptomatic HIV
Inconclusive HIV serology

21. Chapter 2: Neoplasms 140–239 Neoplasm
“New growths or tumors in which cell reproduction is out of control”
Benign
Malignant
(continued)

22. Chapter 2: Neoplasms Six classifications: Primary malignancy
Secondary malignancy
Carcinoma (CA) in situ
Benign
Uncertain behavior
Unspecified nature
(continued)

23. Chapter 2: Neoplasms Contiguous sites (overlapping sites)
Re-excision of tumors

24. 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

25. Chapter 4: Diseases of the Blood and Blood-Forming Organs
280–289
Hematopoiesis
Anemia
Red cell volume
Hemoglobin content
Shape (morphology)
Purpura

26. 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)

27. 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.

28. Chapter 6: Nervous System and Sense Organs
320–389
Nervous system, including meninges
Central nervous system
Brain
Spinal cord
Peripheral nervous system

29. Chapter 7: Circulatory System
390–459
Hypertension, hypertensive table
Malignant (accelerated)
Benign
Unspecified
Cerebral infarction, stroke, CVA
Late effects of cerebrovascular disease
Myocardial infarction

30. 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

31. 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

32. Chapter 10: Genitourinary System
580–629
Chronic kidney disease (CKD)
Kidney transplant status (V42.0)
CKD with other conditions

33. 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)

34. 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)

35. 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)

36. 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)

37. Chapter 12: Skin and Subcutaneous Tissue
680–709
Epidermis, dermis, subcutaneous tissue, nails, sebaceous glands, sweat glands, hair, and hair follicles

38. 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

39. 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

40. 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

41. Chapter 16: Symptoms, Signs, Ill-Defined Conditions
780–799
Includes symptoms, signs, and abnormal results of laboratory or other investigative procedures
(continued)

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

43. Chapter 17: Injury and Poisoning
800–999
Injuries
Fractures
Burns
Adverse effects, poisonings, and toxic effects

44. Fractures Open/Compound fracture Closed/Simple fracture Comminuted
Depressed
Fissured
Greenstick
Impacted
(continued)

45. Fractures Closed/Simple fracture Complicated Malunion (late effect)
Linear
Slipped epiphysis
Spiral fracture
Complicated
Malunion (late effect)

46. Burns 940–949 Classified according to: Depth Extent
First degree (erythema)
Second degree (blistering)
Third degree (full thickness)
Extent
Percentage of body surface
Agent (e.g., chemicals, fire, sun)
E codes assigned

47. 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

48. 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)

49. Poisoning 960–979 Manifestation of poisoning Accidental (E850–E869)
Suicide attempt (E950–E952)
Assault (E961–E962)
Undetermined (E980–E982)

50. Toxic Effects
When someone ingests or comes into contact with a harmful substance

51. 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)

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

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

54. 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)

55. 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)

56. E Codes Place of occurrence (E849)
Describes place where event occurred
Not patient’s activity at the time